Provider Demographics
NPI:1083631725
Name:NORTHWEST HOUSECALL DOCTOR & NURSE PRACTITIONERS
Entity Type:Organization
Organization Name:NORTHWEST HOUSECALL DOCTOR & NURSE PRACTITIONERS
Other - Org Name:NORTHWEST HOUSECALL DOCS AND NP'S
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC, FNP
Authorized Official - Phone:248-218-1198
Mailing Address - Street 1:PO BOX 250463
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-0463
Mailing Address - Country:US
Mailing Address - Phone:248-218-1198
Mailing Address - Fax:248-218-1888
Practice Address - Street 1:9600 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1816
Practice Address - Country:US
Practice Address - Phone:313-623-2813
Practice Address - Fax:248-218-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health