Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 10084 | NH |
Y | 207QS0010X | Family Doctor - Sports Medicine | 10084 | NH |
NPI | 1154340073 |
---|---|
Provider Name | Kristine Ann Karlson |
First Address | Lebanon, NH 03756-0001 |
Second Address | Lebanon, NH 03766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 25/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0RE4539 | (05) | VT |
30010518 | (05) | NH |
F97399 | (02) |