Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 6284-024 | WI |
NPI | 1013969203 |
---|---|
Provider Name | Mrs. Cheryl Lynn Carlson |
First Address | Vulcan, MI 49892-8290 |
Second Address | Vulcan, MI 49892-8290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 01/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
650B210380 | BLUE CROSS (01) | MI |
650B210460 | BCBS (01) | MI |