Provider Demographics
NPI:1093703860
Name:O'HARE, NANCY (CNM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:O'HARE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LAPEER
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:3175 W PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2823
Practice Address - Country:US
Practice Address - Phone:989-667-3377
Practice Address - Fax:989-667-9991
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704148939367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
1002648OtherHEALTH ADVANTAGE PPO
9365130OtherCIGNA PHCS
7380053OtherAETNA
0988156OtherHEALTHPLUS OF MI
1002648OtherMCLAREN HEALTH PLAN
MI1093703860Medicaid
420001344OtherRAILROAD MEDICARE
420G310800OtherBCBS OF MICHIGAN
105570OtherGREAT LAKES HEALTH PLAN
MI4294795Medicaid
209OtherCOMMUNITY CHOICE OF MI
381908328OtherUNITED HEALTH CARE
MI1093703860Medicaid
209OtherCOMMUNITY CHOICE OF MI