Provider Demographics
NPI:1518744499
Name:PSZCZOLKOWSKI, MARISA LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:LEIGH
Last Name:PSZCZOLKOWSKI
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9919 BERWYN
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2120
Mailing Address - Country:US
Mailing Address - Phone:734-386-9425
Mailing Address - Fax:
Practice Address - Street 1:41424 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-8005
Practice Address - Country:US
Practice Address - Phone:734-254-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2024-01-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant