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General NPI Number Information
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NPI Number | 1992487532
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Entity Type | Individual
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Provider Name | MARISSA MERRY PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 1021 E MAIN ST
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City | EDMORE
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State | MI
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Zip | 48829-8740
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Country | US
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Telephone | 989-427-5320
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 HIGHGATE RD
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City | NORTON SHORES
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State | MI
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Zip | 49441-5071
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Country | US
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Telephone | 810-813-9808
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601011716
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License Number State | MI
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