Provider Demographics
NPI:1033190285
Name:JEROW, CARRIE J (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:JEROW
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 LAFAYETTE AVE SE STE 301
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4693
Mailing Address - Country:US
Mailing Address - Phone:616-685-7850
Mailing Address - Fax:616-685-7830
Practice Address - Street 1:310 LAFAYETTE AVE SE STE 301
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4693
Practice Address - Country:US
Practice Address - Phone:616-685-7850
Practice Address - Fax:616-685-7830
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00352020OtherRAILROAD MEDICARE
MI1982921Medicaid
MID17643121Medicare PIN
MIP57201Medicare UPIN