Provider Demographics
NPI:1891753786
Name:MUSICANT, CARRIE D (PA)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:D
Last Name:MUSICANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:D
Other - Last Name:CUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8860 CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7001
Mailing Address - Country:US
Mailing Address - Phone:619-460-6200
Mailing Address - Fax:619-460-6200
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:#240
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-1419
Practice Address - Fax:503-216-2488
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA00821363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
111059Medicare ID - Type Unspecified
P42856Medicare UPIN