Provider Demographics
NPI:1134828221
Name:MARCY, MAYSON LYN (PA-C)
Entity type:Individual
Prefix:
First Name:MAYSON
Middle Name:LYN
Last Name:MARCY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 N WELLS ST APT 903
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3675
Mailing Address - Country:US
Mailing Address - Phone:615-440-1283
Mailing Address - Fax:
Practice Address - Street 1:2418 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2021
Practice Address - Country:US
Practice Address - Phone:773-900-8330
Practice Address - Fax:312-761-1855
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085011338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant