Provider Demographics
NPI:1770652547
Name:NORTIER, NOREEN LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:LOUISE
Last Name:NORTIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NOREEN
Other - Middle Name:LOUISE
Other - Last Name:BOSMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3550 PINE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1944
Mailing Address - Country:US
Mailing Address - Phone:616-485-5602
Mailing Address - Fax:
Practice Address - Street 1:3550 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1944
Practice Address - Country:US
Practice Address - Phone:810-989-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002213363A00000X
PAMA053040363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI002213OtherLICENSE
PAMA053040OtherLICENSE