Healthcare Provider Details

I. General information

NPI: 1487307872
Provider Name (Legal Business Name): CARLENE ANN SHUMAKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLENE ANN CLOUSE

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 N MAIN ST
MALTA OH
43758-9007
US

IV. Provider business mailing address

716 ADAIR AVE
ZANESVILLE OH
43701-2836
US

V. Phone/Fax

Practice location:
  • Phone: 740-896-6111
  • Fax: 740-891-9001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007431RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: