Provider Demographics
NPI:1619185634
Name:LINDIE-FOWLKES, CARLETTA J (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLETTA
Middle Name:J
Last Name:LINDIE-FOWLKES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1 VALLEY HEALTH PLZ FL 3
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3628
Mailing Address - Country:US
Mailing Address - Phone:201-634-5555
Mailing Address - Fax:201-634-5454
Practice Address - Street 1:1 VALLEY HEALTH PLZ FL 3
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3628
Practice Address - Country:US
Practice Address - Phone:201-634-5555
Practice Address - Fax:201-634-5454
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00105500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant