Healthcare Provider Details

I. General information

NPI: 1114337151
Provider Name (Legal Business Name): NANCY ANAYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY ANAYA NAVARRO

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235
US

IV. Provider business mailing address

920 RUTLAND DR APT 416
LINCOLN NE
68512-2173
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-1020
  • Fax:
Mailing address:
  • Phone: 951-255-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number147853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: