Provider Demographics
NPI:1629127485
Name:MISEK, ERIN JR (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:JR
Last Name:MISEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ERIN
Other - Middle Name:JOY
Other - Last Name:ROZELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:70 ORCHARD ACRES
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1308
Mailing Address - Country:US
Mailing Address - Phone:617-233-1796
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1945363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical