Provider Demographics
NPI:1063406841
Name:SOWERS, MARGUERITE B (PA-C)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:B
Last Name:SOWERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5609
Mailing Address - Country:US
Mailing Address - Phone:616-459-8209
Mailing Address - Fax:616-459-0313
Practice Address - Street 1:426 MICHIGAN ST NE
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5609
Practice Address - Country:US
Practice Address - Phone:616-459-8209
Practice Address - Fax:616-459-0313
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002862363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P11870001Medicare ID - Type UnspecifiedMEDICARE PA GROUP NUMBER