Provider Demographics
NPI:1508369752
Name:ELLIOT, MARIELLE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIELLE
Middle Name:
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 CAL DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-9016
Mailing Address - Country:US
Mailing Address - Phone:517-282-5907
Mailing Address - Fax:810-985-5543
Practice Address - Street 1:1515 CAL DR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9016
Practice Address - Country:US
Practice Address - Phone:517-282-5907
Practice Address - Fax:810-985-5543
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704260904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily