Provider Demographics
NPI:1306179494
Name:ALBE, MAUREEN THERESE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:THERESE
Last Name:ALBE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:THERESE
Other - Last Name:FRANKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-281-6372
Mailing Address - Fax:616-281-6459
Practice Address - Street 1:300 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6927
Practice Address - Country:US
Practice Address - Phone:616-281-6372
Practice Address - Fax:616-281-6459
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005605363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306179494Medicaid
MIC36088114Medicare PIN
MI1306179494Medicaid