Provider Demographics
NPI:1225455819
Name:NORDWICK, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:NORDWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:550 6TH AVE NORTH
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-0729
Mailing Address - Country:US
Mailing Address - Phone:406-653-5630
Mailing Address - Fax:406-653-3728
Practice Address - Street 1:550 6TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-0729
Practice Address - Country:US
Practice Address - Phone:406-653-5630
Practice Address - Fax:406-653-3728
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9990118Medicaid