Provider Demographics
NPI:1922070408
Name:STIEG-WILLIAMS, MARCIE L (PAC)
Entity Type:Individual
Prefix:MS
First Name:MARCIE
Middle Name:L
Last Name:STIEG-WILLIAMS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:L
Other - Last Name:STIEG-WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:722 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2040
Mailing Address - Country:US
Mailing Address - Phone:231-796-8665
Mailing Address - Fax:231-796-1629
Practice Address - Street 1:722 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307
Practice Address - Country:US
Practice Address - Phone:231-796-8665
Practice Address - Fax:231-796-1629
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OE455101162Medicare ID - Type Unspecified