Provider Demographics
NPI:1740324664
Name:STRAIGHT, CAROL ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:STRAIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:STRAIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:3601 BLUFF RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8684
Mailing Address - Country:US
Mailing Address - Phone:231-631-1933
Mailing Address - Fax:231-223-4644
Practice Address - Street 1:401 MUNSON AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3041
Practice Address - Country:US
Practice Address - Phone:231-935-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL631409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740324664Medicaid
MI1740324664Medicaid