Provider Demographics
NPI:1144517939
Name:NIZIENSKI, MARIE P (PA-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:P
Last Name:NIZIENSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:245 CHERRY ST SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4607
Mailing Address - Country:US
Mailing Address - Phone:616-459-3551
Mailing Address - Fax:616-459-1060
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-459-3551
Practice Address - Fax:616-459-1060
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2022-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant