Provider Demographics
NPI:1013185016
Name:ST. MARIE, PATRICIA A (PA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:ST. MARIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30513 SPRINGLAND ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4671
Mailing Address - Country:US
Mailing Address - Phone:248-471-1771
Mailing Address - Fax:248-338-5547
Practice Address - Street 1:4756 SQUIRREL HILL DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6608
Practice Address - Country:US
Practice Address - Phone:248-267-0135
Practice Address - Fax:248-338-5547
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001562363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant