Provider Demographics
NPI:1033985783
Name:EMANUEL, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:EMANUEL
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 1:305A W CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-2028
Mailing Address - Country:US
Mailing Address - Phone:715-660-0892
Mailing Address - Fax:
Practice Address - Street 1:305A W CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-2028
Practice Address - Country:US
Practice Address - Phone:715-660-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty