MEDICARE: MARISSA ALBRIGHT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9045	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	251S00000X	Community/Behavioral Health Agency		AZ

General Provider Information

NPI Number	:	1457908311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ALBRIGHT PA-C

Provider Business Mailing Address
First Line	:	734 E DIVISION ST
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-2014
Country	:	US
Telephone Number	:	480-438-2088
Fax Number	:

Provider Business Practice Location Address
First Line	:	4136 N 75TH AVE STE 116
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-3100
Country	:	US
Telephone Number	:	623-247-1234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	05/01/2026

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