Provider Demographics
NPI:1033219266
Name:GRATSON, CORINNE N (PA-C)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:N
Last Name:GRATSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CORRINE
Other - Middle Name:N
Other - Last Name:KIRCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:53568 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-1348
Mailing Address - Country:US
Mailing Address - Phone:616-638-3824
Mailing Address - Fax:
Practice Address - Street 1:43141 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5005
Practice Address - Country:US
Practice Address - Phone:248-333-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5601004806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1071654OtherNCCPA CERTIFICATE
MI5601004806OtherLICENSE
1071654OtherNCCPA CERTIFICATE