Provider Demographics
NPI:1174530398
Name:BERMAN, NANCY B (NP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:B
Last Name:BERMAN
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Gender:F
Credentials:NP
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Mailing Address - Street 1:28625 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1828
Mailing Address - Country:US
Mailing Address - Phone:248-354-9666
Mailing Address - Fax:248-354-3653
Practice Address - Street 1:28625 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 213
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1828
Practice Address - Country:US
Practice Address - Phone:248-354-9666
Practice Address - Fax:248-354-3653
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-11-21
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Provider Licenses
StateLicense IDTaxonomies
MI4704101059363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008668630OtherINDIVIDUAL BS
MI383328522OtherFEDERAL TAX ID