Provider Demographics
NPI:1750858213
Name:ENZWEILER, CARMEN LAUREN
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LAUREN
Last Name:ENZWEILER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MARSH LN APT 1525
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4867
Mailing Address - Country:US
Mailing Address - Phone:859-609-2915
Mailing Address - Fax:
Practice Address - Street 1:8501 JUSTIN RD
Practice Address - Street 2:
Practice Address - City:DOUBLE OAK
Practice Address - State:TX
Practice Address - Zip Code:75077-3031
Practice Address - Country:US
Practice Address - Phone:972-966-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant