Provider Demographics
NPI:1538594841
Name:MORRELL, BETHANY LEEANN (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LEEANN
Last Name:MORRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:650 E BIG BEAVER RD STE A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1432
Mailing Address - Country:US
Mailing Address - Phone:248-663-4401
Mailing Address - Fax:248-377-8640
Practice Address - Street 1:650 E BIG BEAVER RD STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1432
Practice Address - Country:US
Practice Address - Phone:248-663-4401
Practice Address - Fax:248-377-8640
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2024-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant