Provider Demographics
NPI:1801650221
Name:CARBONE, PAUL ANGELO (FNP-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANGELO
Last Name:CARBONE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8947
Mailing Address - Country:US
Mailing Address - Phone:616-885-8369
Mailing Address - Fax:
Practice Address - Street 1:6260 40TH AVE
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8947
Practice Address - Country:US
Practice Address - Phone:616-885-8369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470318914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty