Provider Demographics
NPI:1558873166
Name:BRUBAKER, KARLI MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:KARLI
Middle Name:MICHELE
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARLI
Other - Middle Name:MICHELE
Other - Last Name:STRIETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6092 FENTON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4761
Practice Address - Country:US
Practice Address - Phone:810-239-4697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
390200000X
MI5601011002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program