Provider Demographics
NPI:1043539562
Name:RANCILIO, CARMEN L (CPNP-AC)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:L
Last Name:RANCILIO
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:L
Other - Last Name:LAMBITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-AC
Mailing Address - Street 1:46129 CROWN CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3239
Mailing Address - Country:US
Mailing Address - Phone:586-904-0045
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:CARLS BUILDING SURGICAL SERVICES
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-831-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234681363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics