Provider Demographics
NPI:1487978896
Name:CARWAN, NATALIE (NP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:CARWAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15101 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4611
Mailing Address - Country:US
Mailing Address - Phone:313-582-2769
Mailing Address - Fax:313-846-7708
Practice Address - Street 1:22467 PADDINGTON CT
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-3860
Practice Address - Country:US
Practice Address - Phone:248-880-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704219801363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704219801OtherSTATE LICENSE
MC2127606OtherDEA