Basic Information
| Provider Information | |||||||||
| NPI: | 1013091909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORTHWAY | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS CCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27483 DEQUINDRE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | MADISON HGTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480715711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485410100 | ||||||||
| FaxNumber: | 2483993960 | ||||||||
| Practice Location | |||||||||
| Address1: | 27483 DEQUINDRE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | MADISON HGTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480715711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485410100 | ||||||||
| FaxNumber: | 2483993960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 09/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1601000094 | MI | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 3501004618 | MI | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 4812649 | 05 | MI | MEDICAID | 64OF336900 | 01 | MI | BCBSMI | OTHER | 4812620 | 05 | MI | MEDICAID | 4812602 | 05 | MI | MEDICAID | 4812630 | 05 | MI | MEDICAID |