Basic Information
| Provider Information | |||||||||
| NPI: | 1215106679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWESTERN SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30055 NORTHWESTERN HWY | ||||||||
| Address2: | SUITE L60 | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483343230 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 30055 NORTHWESTERN HWY | ||||||||
| Address2: | SUITE L60 | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483343230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488656555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2008 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOHLFELD | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 2155899024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.