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Individual
CARISSA MICHELLE SPAIN
Active
Individual
CARISSA MICHELLE SPAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002348
IA
363A00000X
Physician Assistant
085.004555
IL
363AM0700X
Medical Physician Assistant
002348
IA
363AS0400X
Surgical Physician Assistant
002348
IA
Other
Enumeration date
11/30/2012
Last updated
05/02/2024
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