Provider Demographics
NPI:1689452575
Name:MORRELL, EMILY JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:MORRELL
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 1:4052 LEGACY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4285
Mailing Address - Country:US
Mailing Address - Phone:517-272-9700
Mailing Address - Fax:
Practice Address - Street 1:4052 LEGACY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4285
Practice Address - Country:US
Practice Address - Phone:517-272-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant