Provider Demographics
NPI:1548341720
Name:CARL, DANA L (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:CARL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-2009
Mailing Address - Country:US
Mailing Address - Phone:517-676-3015
Mailing Address - Fax:517-676-4250
Practice Address - Street 1:1100 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-2009
Practice Address - Country:US
Practice Address - Phone:517-676-3015
Practice Address - Fax:517-676-4250
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220749163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN77190005OtherMEDICARE PIN
MI5008752870OtherBCBS/BCN
MI4688430Medicaid
MIP00183929OtherRAILROAD MEDICARE
MI0N77190OtherGROUP MEDICARE PIN