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NPI Code Detail

MEDICARE: PROF. NANCY MARIE GEORGE PHD,FNP-BC

MEDICARE: PROF. NANCY MARIE GEORGE PHD,FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner4704172835MI
2363LF0000XFamily Nurse Practitioner4704172835MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2086437OTHERMIBCBS
350-5-86-6437-0OTHERMIBCBS
45000012935OTHERMIRAILROAD

General Provider Information

NPI Number : 1598827750
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. NANCY MARIE GEORGE PHD,FNP-BC
Provider Business Mailing Address
First Line : 9021 JOSEPH CAMPAU ST
Second Line :
City : HAMTRAMCK
State : MI
Zip : 48212-3726
Country : US
Telephone Number : 313-871-1926
Fax Number :
Provider Business Practice Location Address
First Line : 33030 VAN BORN RD
Second Line :
City : WAYNE
State : MI
Zip : 48184-2453
Country : US
Telephone Number : 734-858-1940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 12/06/2024

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