Provider Demographics
NPI:1619127164
Name:TORNGA, CHERISSE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERISSE
Middle Name:ANN
Last Name:TORNGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHERISSE
Other - Middle Name:
Other - Last Name:MARIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:10TH FLOOR
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-267-9125
Practice Address - Fax:616-267-1005
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601005361OtherSTATE LICENSE
MI5601005361OtherSTATE LICENSE
MID16299069Medicare PIN