MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER) – Family Nurse Practitioner, NPI 1063422319

MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER) is a healthcare provider. based in Detroit, Michigan. specializing in NURSE PRACTITIONER. They hold the professional credentials NURSE PRACTITIONER. They hold a License No. 1207120 (TX). The NPI Number for MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER) is 1063422319

Main info

Female
26 Years Of Experience
Name
MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER)
NPI
1063422319
Phone
(313) 576-1000
Address
4646 JOHN R ST
Enumeration Date
9 August 2006
Last Update Date
7 October 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2000 (26 years ago)
PAC ID
6608011044
Professional Enrollment ID
I20251023000466
Address ID
MI482010000DE4546XRXXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience71
Completeness85
Years active:19State licenses:2Digital endpointsOther names

8,106 NURSE PRACTITIONER in MI

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Provider Addresses for MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER)

  • John D. Dingell VA Medical Center, 4646, John R Street, Medical Center, Midtown, Detroit, Wayne County, Michigan, 48201, United States

    DETROIT, MI 482011916

    Phone: (313) 576-1000

    Fax: (313) 576-1123

    Type: Location

  • 5085, Westmoreland Drive, Laurelwood Sub, Troy, Oakland County, Michigan, 48085, United States

    TROY, MI 480853443

    Phone: (248) 528-8106

    Fax: (586) 274-3051

    Type: Mailing

  • 9618 PEACH TREE LN

    ROWLETT, TX 750898508

    Phone: (248) 408-8116

    Fax: (248) 408-8116

    Type: Mailing

  • 234 W CAMPBELL RD

    RICHARDSON, TX 750803512

    Phone: (972) 474-3221

    Fax: (512) 782-9316

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48201)

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Reviews

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Frequently asked questions

Can I use this page to confirm MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER)'s NPI?
Yes. MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER) is listed with NPI 1063422319 in the public NPI dataset.
Is MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER) still practicing?
MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER) is currently listed as active in the public NPI registry.
What taxonomy line describes MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER)?
For research purposes, treat MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER) as Family Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER)?
MRS. THRESIAMMA IDICHANDY (NURSE PRACTITIONER)'s geographic hint is Detroit, Michigan in our summary view.
How many locations tie to this NPI?
4 practice locations appear in the available data.