Individual provider Active NPI

Terra Lee Cushman, R.N., BSN., CDE

  • Diabetes Educator Registered Nurse
  • Detroit, MI
National Provider Identifier
1386775526
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diabetes Educator Registered NurseTaxonomy code 163WD0400X
License
4704186479 Issued in MI
Practice address
3031 W Grand Blvd Ste 800
Detroit, MI 48202-3141
Phone
(313) 916-7359
Fax
(313) 916-9027
NPI assigned
Mar 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diabetes Educator Registered Nurse 163WD0400X 4704186479 MI Primary

Addresses

Primary practice location

3031 W Grand Blvd Ste 800
Detroit, MI 48202-3141

Mailing address

12438 Meander
Tecumseh, ONTARIO N8N4P3
CA
Phone (519) 979-0658

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704186479MIMDDiabetes Educator Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386775526",
    "addresses": [
        {
            "country_code": "CA",
            "country_name": "Canada",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "12438 MEANDER",
            "city": "TECUMSEH",
            "state": "ONTARIO",
            "postal_code": "N8N4P3",
            "telephone_number": "519-979-0658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD STE 800",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023141",
            "telephone_number": "313-916-7359",
            "fax_number": "313-916-9027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSHMAN",
        "first_name": "TERRA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "R.N., BSN., CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MI",
            "license": "4704186479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.