Individual
MOLLY MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2122 HEALTH DR SW, WYOMING, MI 49519-9698
(616) 252-7494
(616) 252-7830
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085001725
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601007259
STATE LICENSE NUMBER
MI
Enumeration date
07/10/2006
Last updated
12/08/2017
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