Individual
CARISSA ANN COOROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
720 S VAN BUREN ST STE 301, GREEN BAY, WI 54301-3534
(920) 433-9400
Mailing address
720 S VAN BUREN ST STE 301, GREEN BAY, WI 54301-3534
(920) 433-9400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2872-23
WI
Other
Enumeration date
10/12/2011
Last updated
07/11/2018
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