Healthcare Provider Details

I. General information

NPI: 1063406841
Provider Name (Legal Business Name): MARGUERITE B SOWERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 MICHIGAN ST NE SUITE 201
GRAND RAPIDS MI
49503-5609
US

IV. Provider business mailing address

426 MICHIGAN ST NE SUITE 201
GRAND RAPIDS MI
49503-5609
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-8209
  • Fax: 616-459-0313
Mailing address:
  • Phone: 616-459-8209
  • Fax: 616-459-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601002862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: