Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP30004325 | WA |
NPI | 1821026758 |
---|---|
Provider Name | Patricia M Carlson |
First Address | Spokane, WA 99205-1349 |
Second Address | Spokane, WA 99205-1349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9622598 | (05) | WA |
S97477 | (02) | WA |