Basic Information
| Provider Information | |||||||||
| NPI: | 1174530398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERMAN | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28625 NORTHWESTERN HWY | ||||||||
| Address2: | SUITE 213 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483549666 | ||||||||
| FaxNumber: | 2483543653 | ||||||||
| Practice Location | |||||||||
| Address1: | 28625 NORTHWESTERN HWY | ||||||||
| Address2: | SUITE 213 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483549666 | ||||||||
| FaxNumber: | 2483543653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 11/21/2013 | ||||||||
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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 | 363LA2200X | 4704101059 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 5008668630 | 01 | MI | INDIVIDUAL BS | OTHER | 383328522 | 01 | MI | FEDERAL TAX ID | OTHER |