MEDICARE: DUSTIN DANIEL CARLSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	340594	NY
2	363LF0000X	Family Nurse Practitioner	201702479NP-PP	OR

General Provider Information

NPI Number	:	1497109730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN DANIEL CARLSON FNP

Provider Business Mailing Address
First Line	:	80 SE MADISON ST STE 150
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4527
Country	:	US
Telephone Number	:	971-449-7320
Fax Number	:	949-989-8079

Provider Business Practice Location Address
First Line	:	80 SE MADISON ST STE 150
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4527
Country	:	US
Telephone Number	:	971-449-7320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	04/07/2026

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