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Individual

MRS. MARISSA CARR KENYON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 343-4000
Mailing address
45511 LOUISE CT, UTICA, MI 48317-5782
(586) 567-6664

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007066
MI

Other

Enumeration date
05/03/2015
Last updated
05/03/2015
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