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General NPI Number Information
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NPI Number | 1285460170
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Entity Type | Individual
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Provider Name | CARLEE MARIE ADICKES PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 7870W US HIGHWAY 2
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City | MANISTIQUE
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State | MI
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Zip | 49854-1599
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Country | US
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Telephone | 906-341-2153
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Fax |
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Provider Business Mailing Address
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Address Line | 820 DELAWARE AVE APT F
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City | GRAFTON
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State | WI
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Zip | 53024-9470
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Country | US
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Telephone | 906-241-3352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601012760
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License Number State | MI
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