Provider Demographics
NPI:1326460924
Name:PARISI, MARCY (NP)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:PARISI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:32652 KNO DRIVE
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047
Practice Address - Country:US
Practice Address - Phone:269-782-4141
Practice Address - Fax:269-783-1236
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004756A363LF0000X
IN28175294A363LF0000X
MI4704336810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201211670Medicaid
IN000000862002OtherBCBS BMG E BLAIR WARNER
IN201211670Medicaid