Provider Demographics
NPI:1912923970
Name:MACCHIARELLA, NANCY B (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:MACCHIARELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:B
Other - Last Name:KROHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1005 SOUTH VAN DYKE
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413
Mailing Address - Country:US
Mailing Address - Phone:989-269-3923
Mailing Address - Fax:989-269-3983
Practice Address - Street 1:1005 SOUTH VAN DYKE
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413
Practice Address - Country:US
Practice Address - Phone:989-269-3923
Practice Address - Fax:989-269-3983
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013377207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1653210895OtherBCBSM
MI4624157Medicaid
MI1653210895OtherBCBSM
MIH75970Medicare UPIN
H75970Medicare UPIN