Basic Information
| Provider Information | |||||||||
| NPI: | 1851489504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIEMER | ||||||||
| FirstName: | CARRIE | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 844 KEMPSVILLE RD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7572610701 | ||||||||
| Practice Location | |||||||||
| Address1: | 844 KEMPSVILLE RD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7572610701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 08/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA052579 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 0110003906 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 11673382 | 01 | CAQH | OTHER | 001901262 | 01 | HIGHMARK | OTHER |