Provider Demographics
NPI:1346341385
Name:RICHARDS, CAROLYN MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:RICHARDS
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 1:7696 METCALF RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48006-2726
Mailing Address - Country:US
Mailing Address - Phone:810-387-9355
Mailing Address - Fax:
Practice Address - Street 1:7470 BROCKWAY RD
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:MI
Practice Address - Zip Code:48097-3458
Practice Address - Country:US
Practice Address - Phone:810-387-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003614363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical