Individual
MARCELYN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 MICHIGAN ST NE, SUITE A721, GRAND RAPIDS, MI 49503-2560
(616) 391-3139
(616) 391-3044
Mailing address
100 MICHIGAN ST NE, MC845, GRAND RAPIDS, MI 49503-2560
(616) 486-6557
(616) 486-6702
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
085002748
IL
363AM0700X
Medical Physician Assistant
2326-023
WI
363AM0700X
Medical Physician Assistant
Primary
5601006703
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118606
HEALTH ALLIANCE MEDICAL
IL
05
—
1801986914
—
MI
05
—
43025800
—
WI
01
—
60828
DEAN HEALTH INSURANCE
WI
Enumeration date
10/13/2006
Last updated
02/24/2021
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