Provider Demographics
NPI:1952559288
Name:MOSSING, CAROLYN HOWE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:HOWE
Last Name:MOSSING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 EAST 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423
Mailing Address - Country:US
Mailing Address - Phone:616-395-7585
Mailing Address - Fax:616-395-7144
Practice Address - Street 1:168 E 13TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3624
Practice Address - Country:US
Practice Address - Phone:616-395-7585
Practice Address - Fax:616-395-7144
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant