Provider Demographics
NPI:1205999117
Name:LENEWAY, CAROL A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:LENEWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:PROTHRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1432 S DOBSON RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4768
Mailing Address - Country:US
Mailing Address - Phone:480-412-5550
Mailing Address - Fax:480-412-5434
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:SUITE 402
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-412-5550
Practice Address - Fax:480-412-5434
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ145806Medicare PIN
Z126484Medicare PIN