Provider Demographics
NPI:1265418313
Name:SAWYER, MARCELYN ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:MARCELYN
Middle Name:ANN
Last Name:SAWYER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:104 E SILVERWOOD RANCH EST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4584
Mailing Address - Country:US
Mailing Address - Phone:281-292-5829
Mailing Address - Fax:
Practice Address - Street 1:3131 N WATER ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-2472
Practice Address - Country:US
Practice Address - Phone:217-876-5530
Practice Address - Fax:217-876-5325
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001033363LF0000X
TX727466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILOTH000Medicare UPIN
TX8K6293Medicare UPIN