Individual
MS. VALERIE ANASTASIA CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3034 FISH HATCHERY RD, FITCHBURG, WI 53713-3125
(608) 270-5656
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2899
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1077788
NCCPA CERTIFICATION
IL
01
—
85003005
LICENSED PHYSICIAN ASSISTANT
IL
Enumeration date
07/31/2007
Last updated
04/03/2015
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