Doctor Name: | MARLENE LOUISE PETROVICH |
NPI Number: | 1750404612 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.N. |
License Number: | 4704100811 |
Business Practice Address: | 23050 West Rd Suite210 Brownstown Twp, MI - 481831472 |
Business Phone Number: | 7343627000 |
Business Fax Number: | |
Mailing Address: | 2070 Biddle Ave, Suite 200 WYANDOTTE |
State: | MI |
Postal Code: | 481924080 |
Phone Number: | 7342259112 |
Fax Number: | 7342259176 |
NPI Enumeration Date: | 04/07/2007 |
NPI Last Update Date: | 05/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 4704100811 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |