Provider Demographics
NPI:1063543536
Name:WANK, CAROL A (NP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:WANK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:405 W GREENLAWN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2898
Mailing Address - Country:US
Mailing Address - Phone:517-483-7550
Mailing Address - Fax:517-483-7575
Practice Address - Street 1:405 W GREENLAWN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2898
Practice Address - Country:US
Practice Address - Phone:517-483-7550
Practice Address - Fax:517-483-7575
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704110257363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP13929Medicare UPIN
MI0N17390Medicare ID - Type Unspecified