Wiese, Carolyn Marie

Wiese, Carolyn Marie is an individual health care provider with primary practice located at 2390 Mitchell Park Dr Ste D , Petoskey MI 49770. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Wiese, Carolyn Marie can be contacted via phone (231) 487-7200.

Contact Information

Primary practice address
2390 Mitchell Park Dr Ste D Petoskey MI 49770
Phone: (231) 487-7200
Fax: (231) 487-7188
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA001143 Maine
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5601003704 Michigan

Profile Details

NPI number 1235130576
LBN Legal business name Wiese, Carolyn Marie
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2005
Last updated Jun 12th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235130576 NPPES
Michigan MEDICAID 1235130576

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