Provider Demographics
NPI:1447716154
Name:CLOSE, CARA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:CLOSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODLAWN AVE # LEVEL1
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3105
Mailing Address - Country:US
Mailing Address - Phone:724-438-8765
Mailing Address - Fax:
Practice Address - Street 1:100 WOODLAWN AVE # LEVEL1
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3105
Practice Address - Country:US
Practice Address - Phone:724-438-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant