Provider Demographics
NPI:1285460170
Name:ADICKES, CARLEE MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CARLEE
Middle Name:MARIE
Last Name:ADICKES
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:820 DELAWARE AVE APT F
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9470
Mailing Address - Country:US
Mailing Address - Phone:906-241-3352
Mailing Address - Fax:
Practice Address - Street 1:7870W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-1599
Practice Address - Country:US
Practice Address - Phone:906-341-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601012760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant