Anderson, Marcelyn
Anderson, Marcelyn is an individual health care provider with primary practice located at 100 Michigan St Ne Suite A721, Grand Rapids MI 49503-2560. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Anderson, Marcelyn can be contacted via phone (616) 391-3139.Contact Information
Primary practice address
100 Michigan St Ne Suite A721
Grand Rapids MI 49503-2560
Phone: (616) 391-3139
Fax: (616) 391-3044
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 2326-023 | Wisconsin |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 5601006703 | Michigan |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 085002748 | Illinois |
Profile Details
| NPI number | 1801986914 |
|---|---|
| LBN Legal business name | Anderson, Marcelyn |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 13th, 2006 |
| Last updated | Feb 24th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801986914 | NPPES |
| Michigan | MEDICAID | 1801986914 | |
| Michigan | Other | 118606 | |
| Michigan | MEDICAID | 43025800 | |
| Michigan | Other | 60828 |
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