Provider Demographics
NPI:1598827750
Name:GEORGE, NANCY MARIE (PHD,FNP-BC)
Entity Type:Individual
Prefix:PROF
First Name:NANCY
Middle Name:MARIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHD,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20255 THOROFARE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1228
Mailing Address - Country:US
Mailing Address - Phone:313-720-9743
Mailing Address - Fax:
Practice Address - Street 1:33030 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2453
Practice Address - Country:US
Practice Address - Phone:734-858-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704172835363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI42Q3603Medicaid
MI086437OtherBCBS
MI5000012935OtherRAILROAD
MI50-5-86-6437-0OtherBCBS
MION2700002Medicare ID - Type Unspecified
MI42Q3603Medicaid
MIP0852Medicare UPIN