Provider Demographics
NPI:1043588429
Name:ESTERLY, CAROLYN S (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:ESTERLY
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 1:6 W NEWPORT RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9491
Mailing Address - Country:US
Mailing Address - Phone:717-627-2108
Mailing Address - Fax:717-627-2434
Practice Address - Street 1:6 W NEWPORT RD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7774
Practice Address - Country:US
Practice Address - Phone:717-627-2108
Practice Address - Fax:717-627-2434
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant