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General NPI Number Information
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NPI Number | 1538140777
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Entity Type | Individual
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Provider Name | MARJORIE JANE FREI PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 725 E STATE ST
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City | STERLING
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State | MI
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Zip | 48659-9548
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Country | US
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Telephone | 989-654-2491
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Fax | 989-654-2190
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Provider Business Mailing Address
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Address Line | 3836 STANDISH RD
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City | RHODES
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State | MI
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Zip | 48652-9514
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Country | US
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Telephone | 989-879-3968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601003817
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License Number State | MI
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