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NPI Code Detail

MEDICARE: GABRIELLE MARIE CARTER PHYSICIAN ASSISTANT

MEDICARE: GABRIELLE MARIE CARTER PHYSICIAN ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601012907MI

General Provider Information

NPI Number : 1235692526
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE MARIE CARTER PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 1490 E BELTLINE AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-4336
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6401 PRAIRIE ST STE 2600
Second Line :
City : NORTON SHORES
State : MI
Zip : 49444-7842
Country : US
Telephone Number : 231-672-7900
Fax Number : 231-672-7914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2019
Last Update Date : 12/31/2024

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Directions to “ GABRIELLE MARIE CARTER PHYSICIAN ASSISTANT” Practice Location

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