Provider Demographics
NPI:1629587217
Name:MARC, MICHAELA (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:
Last Name:MARC
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NELKIN DR APT 285
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-2717
Mailing Address - Country:US
Mailing Address - Phone:862-216-6053
Mailing Address - Fax:
Practice Address - Street 1:29 NELKIN DRIVE
Practice Address - Street 2:APT 285
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057
Practice Address - Country:US
Practice Address - Phone:862-216-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00733500363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health