Individual
DONNA JEAN MARVICSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3535 W 13 MILE RD, SUITE 707, ROYAL OAK, MI 48073-6770
(248) 551-0487
(248) 551-3696
Mailing address
3535 W 13 MILE RD, SUITE 707, ROYAL OAK, MI 48073-6770
(248) 551-0487
(248) 551-3696
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704135783
MI
363LP0200X
Pediatric Nurse Practitioner
Primary
4704135783
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4578770
—
MI
01
—
500F318190
BCBSM
MI
Enumeration date
07/31/2006
Last updated
06/17/2025
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