Individual
CARLYE J HENLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
721 6TH AVE, THREE RIVERS, MI 49093-8358
(269) 273-9782
(269) 273-9711
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007051
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538574090
—
MI
Enumeration date
06/24/2014
Last updated
08/04/2023
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