Individual
MRS. ASHLEY FAYE MORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2950 KEEWAHDIN RD, FORT GRATIOT, MI 48059-3526
(810) 455-1600
(810) 455-1620
Mailing address
43151 DALCOMA DR STE 4, CLINTON TOWNSHIP, MI 48038-6306
(586) 286-8720
(866) 790-6803
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5601007084
MI
Other
Enumeration date
09/22/2014
Last updated
10/26/2023
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