Individual
MRS. MARLA D CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
605 THIRD AVENUE, SUITE B, FREMONT, OH 43420
(567) 201-2890
Mailing address
605 THIRD AVENUE, SUITE B, FREMONT, OH 43420
(567) 201-2890
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.003055
OH
363AM0700X
Medical Physician Assistant
5601006448
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0071368
—
OH
Enumeration date
03/11/2010
Last updated
10/07/2016
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