Provider Demographics
NPI:1306064308
Name:PLOTT, CARMEN (NP-C)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:PLOTT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST STE 185
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2296
Mailing Address - Country:US
Mailing Address - Phone:231-487-3390
Mailing Address - Fax:231-487-3578
Practice Address - Street 1:560 W MITCHELL ST STE 185
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2296
Practice Address - Country:US
Practice Address - Phone:231-487-3390
Practice Address - Fax:231-487-3578
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135786363LF0000X
TNAPN11882363LF0000X
MI4704300983363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily