Provider Demographics
NPI:1992487532
Name:MERRY, MARISSA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MERRY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:3850 HIGHGATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5071
Mailing Address - Country:US
Mailing Address - Phone:810-813-9808
Mailing Address - Fax:
Practice Address - Street 1:1021 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-8740
Practice Address - Country:US
Practice Address - Phone:989-427-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant