Provider Demographics
NPI:1538140777
Name:FREI, MARJORIE JANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:JANE
Last Name:FREI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 STANDISH RD
Mailing Address - Street 2:
Mailing Address - City:RHODES
Mailing Address - State:MI
Mailing Address - Zip Code:48652-9514
Mailing Address - Country:US
Mailing Address - Phone:989-879-3968
Mailing Address - Fax:
Practice Address - Street 1:725 E STATE ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9548
Practice Address - Country:US
Practice Address - Phone:989-654-2491
Practice Address - Fax:989-654-2190
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical