Healthcare Provider Details

I. General information

NPI: 1457908311
Provider Name (Legal Business Name): MARISSA ALBRIGHT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 N 75TH AVE STE 116
PHOENIX AZ
85033-3100
US

IV. Provider business mailing address

734 E DIVISION ST
CADILLAC MI
49601-2014
US

V. Phone/Fax

Practice location:
  • Phone: 623-247-1234
  • Fax:
Mailing address:
  • Phone: 480-438-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9045
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: