Provider Demographics
NPI:1730646696
Name:BAHRA, MAREN (PA)
Entity type:Individual
Prefix:
First Name:MAREN
Middle Name:
Last Name:BAHRA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MAREN
Other - Middle Name:
Other - Last Name:MCHENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:3480 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9354
Mailing Address - Country:US
Mailing Address - Phone:269-224-6554
Mailing Address - Fax:269-224-6537
Practice Address - Street 1:3480 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9354
Practice Address - Country:US
Practice Address - Phone:269-224-6554
Practice Address - Fax:269-224-6537
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5601009035363A00000X
MI5601008989TMP363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant