Individual
MRS. MARY THERESE FORNETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MMS PA-C
Contact information
Practice address
325 E H ST, IRON MOUNTAIN, MI 49801-4760
(906) 774-3300
Mailing address
325 E H ST, IRON MOUNTAIN, MI 49801-4760
(906) 774-3300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2012005497
MO
Other
Enumeration date
12/03/2011
Last updated
06/17/2013
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