MARISSA CALLICOTTE (NPI# 1588225338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588225338 |
| Entity Type | Individual |
| Full Name | MARISSA CALLICOTTE |
| Credential | PA-C |
| Practice Address |
8765 Lewis Ave Temperance MI 48182-9300 |
| Mailing Address |
120 Marshall Dr Swanton OH 43558-1422 |
| Practice Telephone | 7346542169 |
| Mailing Telephone | 5676949394 |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2019-07-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 5601009570 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 50.006009RX | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 120 Marshall Dr, Swanton, OH 435581422 | 5676949394 |
| Street Address |
8765 LEWIS AVE |
| City | TEMPERANCE |
| State | MI |
| Zip Code | 48182-9300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992791453 | William J Demots | Family Medicine | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2005-09-21 |
| 1972158236 | Rechawn A Fair | Dental Hygienist | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2019-08-05 |
| 1205497088 | Serina J Vanderbush | Social Worker | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2019-06-24 |
| 1508321118 | Christie Blevins | Dental Hygienist | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2019-02-07 |
| 1366912768 | Kailah Rayne Ayres-clifft | Counselor | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2018-11-28 |
| 1679021240 | Erica Keith | Social Worker | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2016-09-13 |
| 1346616869 | Candace Kovar | Psychologist | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2015-08-19 |
| 1639421035 | Famly Medical Center of Michigan, Inc | Dentist | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2012-10-09 |
| 1619241692 | Ahmed Mahboob Syeda | Dentist | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2012-03-08 |
| 1043511470 | Laurie Ann Fry | Nurse Practitioner | 8765 Lewis Ave, Temperance, MI 48182-9583 | 2010-11-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982186771 | Ruben J Loo | Physical Therapist | 2000 W. Dean Road, Temperance, MI 48182 | 2018-08-29 |
| 1356881460 | Chelsea Engler | Licensed Practical Nurse | 22230 Camille, Temperance, MI 48182 | 2017-03-08 |
| 1801252291 | Charles Dean Tabbert | Nurse Anesthetist, Certified Registered | 3661 Saint Anthony Rd, Temperance, MI 48182 | 2016-01-14 |
| 1023360229 | Tamara Ruth Ciha | Technician, Other | 1070 North Park Dr, Temperance, MI 48182 | 2012-10-11 |
| 1356651004 | Meghanne Denise Decant | Registered Nurse | 2128 W Rauch Rd, Temperance, MI 48182 | 2010-10-15 |
| 1639325202 | Joanne Marie Segura | Licensed Practical Nurse | 6711 Summerfield, Temperance, MI 48182 | 2008-08-14 |
| 1952564775 | Kaye Cecelia Shepherd | Home Health Aide | 3346 St Anthony Road, Temperance, MI 48182 | 2008-07-02 |
| 1467638494 | Aspen Ridge, LLC | Skilled Nursing Facility | 951 Hickory Creek Blvd., Temperance, MI 48182 | 2008-01-22 |
| 1144406703 | Liberty Compounding Pharmacy, LLC | Pharmacy | 7355 Lewis Ave, Suite D, Temperance, MI 48182 | 2008-01-14 |
| 1760698724 | Rebecca Ann Pasko | Counselor | 9035 Lewis Ave, Temperance, MI 48182 | 2007-05-15 |
| Find all providers in zip 48182 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164022331 | Anna Lynn Shrift | Physician Assistant | 849 Black Hill Ln, Traverse City, MI 49696-8674 | 2020-10-27 |
| 1972102556 | Aaron Buckley | Physician Assistant | 567 Saint Louis St, Ferndale, MI 48220-2436 | 2020-10-23 |
| 1013516194 | Rebecca Mary Cronin | Physician Assistant | 4311 Kingsbrook Dr, Kalamazoo, MI 49006-3909 | 2020-10-20 |
| 1801495023 | Keriah Khairi Abd | Physician Assistant | 42836 Bloomingdale Dr, Sterling Heights, MI 48314-2843 | 2020-10-19 |
| 1154929016 | Angela Varghese | Physician Assistant | 461 Tanner Dr, Troy, MI 48085-4714 | 2020-10-13 |
| 1861090730 | Maloree Blayke Perkins | Physician Assistant | 20717 Coventry St, Clinton Twp, MI 48035-1603 | 2020-10-13 |
| 1801494000 | Sarah Puchala Lucero | Physician Assistant | 25614 Wilson Dr, Dearborn Heights, MI 48127-3427 | 2020-10-12 |
| 1871191007 | Julia Marie Tucker | Physician Assistant | 12250 E Ridge Dr, Bruce Twp, MI 48065-2011 | 2020-10-10 |
| 1164020301 | Sara Whitneyann Vandeman | Physician Assistant | 7901 S 12th St Ste 101, Portage, MI 49024-3831 | 2020-10-10 |
| 1831796267 | Jowharh Zindani | Physician Assistant | 12020 Mitchell St, Hamtramck, MI 48212-2722 | 2020-10-08 |
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| City | TEMPERANCE |
| Zip Code | 48182 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.