Provider Demographics
NPI:1720859895
Name:MENIE, CAROLINE VICTORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:VICTORIA
Last Name:MENIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:VICTORIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:636-717-6775
Mailing Address - Fax:636-717-6755
Practice Address - Street 1:714 GRAVOIS RD STE 115
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7723
Practice Address - Country:US
Practice Address - Phone:636-717-6775
Practice Address - Fax:636-717-6755
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant