Provider Demographics
NPI:1861578650
Name:PIERRE-OUTLAR, CAROLYN (RPAC)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:PIERRE-OUTLAR
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPAC
Mailing Address - Street 1:820 BOYNTON AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4615
Mailing Address - Country:US
Mailing Address - Phone:646-734-8428
Mailing Address - Fax:406-289-4428
Practice Address - Street 1:110 W 97TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6450
Practice Address - Country:US
Practice Address - Phone:212-749-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011553363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant