Provider Demographics
NPI:1689252116
Name:MCCARTHY, CARRI DAWN (NP-C)
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:DAWN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HOLLYWOOD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8511
Mailing Address - Country:US
Mailing Address - Phone:269-428-0819
Mailing Address - Fax:269-428-0841
Practice Address - Street 1:3800 HOLLYWOOD RD STE 104
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8511
Practice Address - Country:US
Practice Address - Phone:269-428-0819
Practice Address - Fax:269-428-0841
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704167106363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology