1093703860 NPI number — NANCY O'HARE CNM

Table of content: NANCY O'HARE CNM (NPI 1093703860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093703860 NPI number — NANCY O'HARE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'HARE
Provider First Name:
NANCY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1093703860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 LAPEER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48607-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-759-6464
Provider Business Mailing Address Fax Number:
989-399-8233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3175 W PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-667-3377
Provider Business Practice Location Address Fax Number:
989-667-9991
Provider Enumeration Date:
10/06/2005

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: 367A00000X , with the licence number:  4704148939 , 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: 1002648 . This is a "HEALTH ADVANTAGE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9365130 . This is a "CIGNA PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7380053 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0988156 . This is a "HEALTHPLUS OF MI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1002648 . This is a "MCLAREN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1093703860 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 420001344 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 420G310800 . This is a "BCBS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 105570 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4294795 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209 . This is a "COMMUNITY CHOICE OF MI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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