Provider Demographics
NPI:1093861593
Name:PIERSMA, CARL E (PA-C)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:PIERSMA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11315 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9396
Mailing Address - Country:US
Mailing Address - Phone:616-895-2000
Mailing Address - Fax:616-895-2009
Practice Address - Street 1:11315 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9396
Practice Address - Country:US
Practice Address - Phone:616-895-2000
Practice Address - Fax:616-895-2009
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant