Provider Demographics
NPI:1205384906
Name:NAMDE, CAROLYN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:NAMDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:MENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 SITUS CT
Mailing Address - Street 2:STE 190
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1130 SITUS CT
Practice Address - Street 2:STE 190
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3391
Practice Address - Country:US
Practice Address - Phone:919-792-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC258185163W00000X
NC0010-06717363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse