Provider Demographics
NPI:1235176934
Name:SHEARER, CAROLYN (PA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SHEARER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-327-0872
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:5301 E HURON RIVER DR
Practice Address - Street 2:C139
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-1000
Practice Address - Fax:734-712-1012
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001685363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical