Healthcare Provider Details

I. General information

NPI: 1043457534
Provider Name (Legal Business Name): CARRIE ANN ASSENMACHER P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SHAFFER STREET
KALAMAZOO MI
49048-1604
US

IV. Provider business mailing address

1820 SHAFFER STREET
KALAMAZOO MI
49048-1604
US

V. Phone/Fax

Practice location:
  • Phone: 269-381-7136
  • Fax: 269-381-6665
Mailing address:
  • Phone: 269-381-7136
  • Fax: 269-381-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601002559
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: