Provider Demographics
NPI:1457168072
Name:SALVESEN, MARLAYNA GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:MARLAYNA
Middle Name:GRACE
Last Name:SALVESEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CIDER MILL CIR
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1956
Mailing Address - Country:US
Mailing Address - Phone:908-442-6818
Mailing Address - Fax:
Practice Address - Street 1:267 HWY 202/31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-3458
Practice Address - Country:US
Practice Address - Phone:908-788-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00886800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical