Provider Demographics
NPI:1790904498
Name:HAISLIP-RAMBO, CAROLE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LYNN
Last Name:HAISLIP-RAMBO
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 1:192 MCBRIDE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-9255
Mailing Address - Country:US
Mailing Address - Phone:906-440-6973
Mailing Address - Fax:
Practice Address - Street 1:351 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3877
Practice Address - Country:US
Practice Address - Phone:336-783-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant