Provider Demographics
NPI:1750645644
Name:KABLE, MARCIE ELLEN (PA)
Entity Type:Individual
Prefix:MS
First Name:MARCIE
Middle Name:ELLEN
Last Name:KABLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MARCIE
Other - Middle Name:ELLEN
Other - Last Name:SCHLAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-0000
Mailing Address - Fax:989-583-2811
Practice Address - Street 1:1447 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4727
Practice Address - Country:US
Practice Address - Phone:989-583-0000
Practice Address - Fax:989-583-2811
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant