Healthcare Provider Details

I. General information

NPI: 1720551237
Provider Name (Legal Business Name): MERRISA CARLSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 IMPERIAL HWY
DOWNEY CA
90242-2814
US

IV. Provider business mailing address

7303 E EQUITATION WAY
ORANGE CA
92869-1020
US

V. Phone/Fax

Practice location:
  • Phone: 714-855-8344
  • Fax:
Mailing address:
  • Phone: 714-396-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95010406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: