Provider Demographics
NPI:1790180867
Name:EGAN, EMILY MARIAN-HENDERSON (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIAN-HENDERSON
Last Name:EGAN
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MARIAN
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:532 DARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2141
Mailing Address - Country:US
Mailing Address - Phone:484-880-6703
Mailing Address - Fax:
Practice Address - Street 1:1579 DUCK DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48855-6429
Practice Address - Country:US
Practice Address - Phone:484-880-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009994363A00000X
PART0055362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer