Provider Demographics
NPI:1497303440
Name:YELLIN, MARISA PARKER (PA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:PARKER
Last Name:YELLIN
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 1:2445 BURNT TREE LN APT 9
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7116
Mailing Address - Country:US
Mailing Address - Phone:512-569-0338
Mailing Address - Fax:
Practice Address - Street 1:2090 JOLLY RD STE 150
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6036
Practice Address - Country:US
Practice Address - Phone:517-349-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program