Provider Demographics
NPI:1487307872
Name:SHUMAKER, CARLENE ANN (PA)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:ANN
Last Name:SHUMAKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:ANN
Other - Last Name:CLOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:716 ADAIR AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:859 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758-9007
Practice Address - Country:US
Practice Address - Phone:740-896-6111
Practice Address - Fax:740-891-9001
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007431RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant