Provider Demographics
NPI:1508840950
Name:ESPINOZA, CAREY A (PA)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:A
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:A
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2736
Mailing Address - Country:US
Mailing Address - Phone:906-225-3993
Mailing Address - Fax:906-225-4589
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2736
Practice Address - Country:US
Practice Address - Phone:906-225-3993
Practice Address - Fax:906-225-4589
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004114OtherMICHIGAN LICENSE NUMBER
MI0N89960001Medicare PIN
MIQ14535Medicare UPIN