Provider Demographics
NPI:1043457534
Name:ASSENMACHER, CARRIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:ASSENMACHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SHAFFER STREET
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1604
Mailing Address - Country:US
Mailing Address - Phone:269-381-7136
Mailing Address - Fax:269-381-6665
Practice Address - Street 1:1820 SHAFFER STREET
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1604
Practice Address - Country:US
Practice Address - Phone:269-381-7136
Practice Address - Fax:269-381-6665
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700C915330OtherBLUE CROSS BLUE SHIELD
MI700C915330OtherBLUE CROSS BLUE SHIELD