Provider Demographics
NPI:1912672379
Name:CARMAN, AZURAE RAIN
Entity Type:Individual
Prefix:
First Name:AZURAE
Middle Name:RAIN
Last Name:CARMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AZURAE
Other - Middle Name:RAIN
Other - Last Name:CARMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GRADUATE
Mailing Address - Street 1:20009 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELSIE
Mailing Address - State:MI
Mailing Address - Zip Code:48831-9203
Mailing Address - Country:US
Mailing Address - Phone:989-307-5917
Mailing Address - Fax:
Practice Address - Street 1:20009 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELSIE
Practice Address - State:MI
Practice Address - Zip Code:48831-9203
Practice Address - Country:US
Practice Address - Phone:989-307-5917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156F00000X
156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist