Provider Demographics
NPI:1497418180
Name:MULARONI, PHOEBE MARCELLA (PA)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:MARCELLA
Last Name:MULARONI
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 1:3103 HIDDEN COVE CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-4947
Mailing Address - Country:US
Mailing Address - Phone:810-588-3274
Mailing Address - Fax:
Practice Address - Street 1:46325 W 12 MILE RD STE 370
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2464
Practice Address - Country:US
Practice Address - Phone:248-482-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010859APP21363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty