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General NPI Number Information
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NPI Number | 1427525542
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Entity Type | Individual
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Provider Name | MISS CARRIE CARISSA AKIN
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Gender | Female
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 875 PRE EMPTION RD
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City | GENEVA
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State | NY
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Zip | 14456-2042
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Country | US
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Telephone | 315-789-5061
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Fax |
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Provider Business Mailing Address
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Address Line | 17 ECKERSON AVE
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City | AKRON
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State | NY
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Zip | 14001
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Country | US
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Telephone | 716-923-3435
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 025060
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License Number State | NY
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