MEDICARE: NOREEN LOUISE NORTIER PA-C

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
1	363A00000X	Physician Assistant	002213	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002213	OTHER	MI	LICENSE

General Provider Information

NPI Number	:	1770652547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOREEN LOUISE NORTIER PA-C

Provider Business Mailing Address
First Line	:	3550 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-1944
Country	:	US
Telephone Number	:	616-485-5602
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-1944
Country	:	US
Telephone Number	:	810-989-2530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	03/17/2018

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