Provider Demographics
NPI:1831345263
Name:HILL, MARCELLA (PA-C)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:HILL
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 1:850 N OTSEGO AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1568
Mailing Address - Country:US
Mailing Address - Phone:989-731-7777
Mailing Address - Fax:989-731-7776
Practice Address - Street 1:2572 N US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:MI
Practice Address - Zip Code:49730-8252
Practice Address - Country:US
Practice Address - Phone:989-731-7700
Practice Address - Fax:989-731-2999
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF96004OtherMEDICARE GROUP NUMBER