Individual
MRS. MARILYN PELLETIER MADAJCZYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
21380 31 MILE RD, RAY, MI 48096-1319
(989) 254-0576
Mailing address
21380 31 MILE RD, RAY, MI 48096-1319
(989) 254-0576
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704236178
MI
363LF0000X
Family Nurse Practitioner
Primary
11200003
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11200003
—
MI
Enumeration date
05/15/2008
Last updated
12/11/2020
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