Provider Demographics
NPI:1013091909
Name:NORTHWAY, NANCY ANN (MS CCA)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:NORTHWAY
Suffix:
Gender:F
Credentials:MS CCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27483 DEQUINDRE
Mailing Address - Street 2:STE 201
Mailing Address - City:MADISON HGTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5711
Mailing Address - Country:US
Mailing Address - Phone:248-541-0100
Mailing Address - Fax:248-399-3960
Practice Address - Street 1:27483 DEQUINDRE
Practice Address - Street 2:STE 201
Practice Address - City:MADISON HGTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5711
Practice Address - Country:US
Practice Address - Phone:248-541-0100
Practice Address - Fax:248-399-3960
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000094231H00000X
MI3501004618237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4812649Medicaid
MI64OF336900OtherBCBSMI
MI4812620Medicaid
MI4812602Medicaid
MI4812630Medicaid