Provider Demographics
NPI:1780845560
Name:DAHL, CARRIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:DAHL
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 1:725 S JANESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-1775
Mailing Address - Country:US
Mailing Address - Phone:608-868-5800
Mailing Address - Fax:
Practice Address - Street 1:725 S JANESVILLE ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-1775
Practice Address - Country:US
Practice Address - Phone:608-868-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1081566363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1081566OtherCERTIFICATION ID