Provider Demographics
NPI:1700018249
Name:DARDINE, CARRIE LYNN (PAC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:DARDINE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4416
Mailing Address - Country:US
Mailing Address - Phone:610-692-4382
Mailing Address - Fax:610-430-6820
Practice Address - Street 1:531 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4416
Practice Address - Country:US
Practice Address - Phone:610-692-4382
Practice Address - Fax:610-430-6820
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant