Provider Demographics
NPI:1669500039
Name:MERIDITH, CARMEN EVELINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:EVELINE
Last Name:MERIDITH
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 1:21585 N 77TH AVE
Mailing Address - Street 2:STE 1500
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2138
Mailing Address - Country:US
Mailing Address - Phone:623-582-0953
Mailing Address - Fax:
Practice Address - Street 1:8412 E. SHEA BLVD. STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-874-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant