Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 14220 | CA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN45545 | RI |
NPI | 1023077674 |
---|---|
Provider Name | Miss Amanda Waldheim Carlson |
First Address | Newport, RI 02840-3503 |
Second Address | Warwick, RI 02886-2759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 18/07/2008 |