Healthcare Provider Details

I. General information

NPI: 1336365584
Provider Name (Legal Business Name): ANDREA MARIE MORIN ATC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N MAIN ST
LAPEER MI
48446-1350
US

IV. Provider business mailing address

2789 GENES DR
AUBURN HILLS MI
48326-1905
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-5500
  • Fax:
Mailing address:
  • Phone: 586-604-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: