Healthcare Provider Details

I. General information

NPI: 1841692001
Provider Name (Legal Business Name): MARA GRAY ARNETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARA GRAY COLE PA-C

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2531
US

IV. Provider business mailing address

1090 ARNOLD DR 19TH MEDICAL GROUP
LITTLE ROCK AIR FORCE BASE AR
72099-4933
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-7900
  • Fax: 616-267-7901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: