Provider Demographics
NPI:1497076434
Name:MORSE, MARY BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:MORSE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3901 BEAUBIEN
Mailing Address - Street 2:CHILDREN'S HOSPITAL OF MICHIGAN
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5260
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:4201 ST. ANTOINE - UHC 5D #226
Practice Address - Street 2:UNIVERSITY PEDIATRICIANS
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4405
Practice Address - Fax:313-966-0665
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2016-12-06
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Provider Licenses
StateLicense IDTaxonomies
MI5601005759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant