Provider Demographics
NPI:1972715787
Name:SOUTAR, MARCY LEE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARCY
Middle Name:LEE
Last Name:SOUTAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3225
Mailing Address - Country:US
Mailing Address - Phone:248-635-7309
Mailing Address - Fax:
Practice Address - Street 1:1449 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3225
Practice Address - Country:US
Practice Address - Phone:248-635-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249796163WM0705X
CATL6068871012163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical