Provider Demographics
NPI:1942181359
Name:WABANIMKEE-MINZEY, MARION I
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:I
Last Name:WABANIMKEE-MINZEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 N WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PESHAWBESTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9275
Mailing Address - Country:US
Mailing Address - Phone:231-534-7091
Mailing Address - Fax:
Practice Address - Street 1:2605 N WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:PESHAWBESTOWN
Practice Address - State:MI
Practice Address - Zip Code:49682-9275
Practice Address - Country:US
Practice Address - Phone:231-534-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803088705172V00000X, 175T00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No175T00000XOther Service ProvidersPeer Specialist