Provider Demographics
NPI:1063572766
Name:MINTO, CARRIE LEE (PA-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEE
Last Name:MINTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11293 N M37
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUCKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49620
Mailing Address - Country:US
Mailing Address - Phone:231-269-4185
Mailing Address - Fax:231-269-4461
Practice Address - Street 1:11293 S M 37
Practice Address - Street 2:SUITE A
Practice Address - City:BUCKLEY
Practice Address - State:MI
Practice Address - Zip Code:49620-9593
Practice Address - Country:US
Practice Address - Phone:231-269-4185
Practice Address - Fax:231-269-4461
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant