Provider Demographics
NPI:1134311152
Name:PISANI, CARRIEANNE (PA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIEANNE
Middle Name:
Last Name:PISANI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:CARRIEANNE
Other - Middle Name:
Other - Last Name:MULVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:179 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1019
Mailing Address - Country:US
Mailing Address - Phone:607-843-9816
Mailing Address - Fax:607-843-4619
Practice Address - Street 1:179 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1019
Practice Address - Country:US
Practice Address - Phone:607-843-9816
Practice Address - Fax:607-843-4619
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053864363A00000X
NY007655363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant