MEDICARE: CARRIE AFFIELD PA-C

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
1	363AM0700X	Medical Physician Assistant	1098	MN

General Provider Information

NPI Number	:	1881889673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE AFFIELD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 737
Second Line	:
City	:	PELICAN RAPIDS
State	:	MN
Zip	:	56572-0737
Country	:	US
Telephone Number	:	218-863-6100
Fax Number	:	218-863-6173

Provider Business Practice Location Address
First Line	:	211 EAST MILL STREET
Second Line	:
City	:	PELICAN RAPIDS
State	:	MN
Zip	:	56572-0737
Country	:	US
Telephone Number	:	218-863-6100
Fax Number	:	218-863-6173

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	02/19/2008

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Directions to “ CARRIE AFFIELD PA-C” Practice Location

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