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Individual
JANINE M CARROLL
Active
Individual
JANINE M CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055-0030203
VT
363A00000X
Physician Assistant
0550030203
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005117
—
VT
01
—
200010961
RAILROAD MEDICARE/ PALMETTO
VT
01
—
635529
MVP
VT
05
—
9000271
—
VT
01
—
GRTH18953
BC/BS
VT
Enumeration date
08/31/2005
Last updated
09/14/2010
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