Provider Demographics
NPI:1972718765
Name:HARRISON, MARZELLA J (RPA)
Entity type:Individual
Prefix:
First Name:MARZELLA
Middle Name:J
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2736
Mailing Address - Country:US
Mailing Address - Phone:716-375-7500
Mailing Address - Fax:716-701-6853
Practice Address - Street 1:9864 LUCKEY DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:NY
Practice Address - Zip Code:14744-8706
Practice Address - Country:US
Practice Address - Phone:716-375-7500
Practice Address - Fax:716-701-6853
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01357340Medicaid
NY01357340Medicaid