Active NPI
Wanda Elaine Pettway-Norris, LLMSW
- Social Worker
- Southgate, MI
National Provider Identifier
1790129518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801099255
- Practice address
- 13101 Allen Rd
Southgate, MI 48195-2216 - Phone
- (734) 785-7700
- NPI assigned
- Apr 23, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801099255 | MI | Primary |
Addresses
Primary practice location
13101 Allen Rd
Southgate, MI 48195-2216
Mailing address
10351 Dartmouth St
Oak Park, MI 48237-1705
Phone (248) 242-0453
Other practice location 1
279 Summit Dr
Waterford, MI 48328-3364
Phone (248) 521-9526
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1234567 | Other | MI | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801099255 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565827200000",
"number": "1790129518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10351 DARTMOUTH ST",
"city": "OAK PARK",
"state": "MI",
"postal_code": "482371705",
"telephone_number": "248-242-0453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13101 ALLEN RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952216",
"telephone_number": "734-785-7700"
}
],
"practiceLocations": [
{
"address_1": "279 Summit Dr",
"address_purpose": "LOCATION",
"city": "Waterford",
"state": "MI",
"postal_code": "483283364",
"country_code": "US",
"telephone_number": "248-521-9526",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETTWAY-NORRIS",
"first_name": "WANDA",
"middle_name": "ELAINE",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-23",
"last_updated": "2019-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801099255",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1234567",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.