Provider Demographics
NPI:1629641261
Name:CHANCE, GARRETT DONALD (PA-C)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:DONALD
Last Name:CHANCE
Suffix:
Gender:M
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 1:10743 OAK LN APT 16316
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4757
Mailing Address - Country:US
Mailing Address - Phone:734-716-3845
Mailing Address - Fax:
Practice Address - Street 1:10743 OAK LN APT 16316
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-4757
Practice Address - Country:US
Practice Address - Phone:734-716-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant