Individual
MARISSA SUE MADISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-2101
Mailing address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
9941
AZ
363A00000X
Physician Assistant
Primary
9941
AZ
Other
Enumeration date
07/11/2022
Last updated
11/01/2023
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