Provider Demographics
NPI:1861568230
Name:MARANTO, NANCY A (AUD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:MARANTO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:6777 WEST MAPLE ROAD
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323
Mailing Address - Country:US
Mailing Address - Phone:248-661-6455
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:6777 WEST MAPLE ROAD
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323
Practice Address - Country:US
Practice Address - Phone:248-661-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002079231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI322413290Medicaid
NM002079OtherCHAMPUS-CHAMPUS
NM002079OtherCOMMERCIAL-COMMERCIAL NUMBER
640H279690OtherBLUE CROSS-BLUE CROSS
NM002079OtherCHAMPUS-CHAMPUS
MI322413290Medicaid