1013091909 NPI number — MS. NANCY ANN NORTHWAY MS CCA

Table of content: MS. NANCY ANN NORTHWAY MS CCA (NPI 1013091909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013091909 NPI number — MS. NANCY ANN NORTHWAY MS CCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORTHWAY
Provider First Name:
NANCY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013091909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27483 DEQUINDRE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
MADISON HGTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48071-5711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-541-0100
Provider Business Mailing Address Fax Number:
248-399-3960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27483 DEQUINDRE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
MADISON HGTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48071-5711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-541-0100
Provider Business Practice Location Address Fax Number:
248-399-3960
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  1601000094 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 3501004618 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4812649 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64OF336900 . This is a "BCBSMI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4812620 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4812602 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4812630 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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