Provider Demographics
NPI:1689180168
Name:RECKLING, CAROLINE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANN
Last Name:RECKLING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CAROLINE
Other - Middle Name:ANN
Other - Last Name:EGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7125 ORCHARD LAKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3616
Mailing Address - Country:US
Mailing Address - Phone:248-865-7481
Mailing Address - Fax:
Practice Address - Street 1:7125 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3615
Practice Address - Country:US
Practice Address - Phone:248-865-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant