Healthcare Provider Details

I. General information

NPI: 1316950975
Provider Name (Legal Business Name): LAUREL ANNE CARLSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA SAN DIEGO HEALTHCARE SYSTEM 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

PO BOX 231579
ENCINITAS CA
92023-1579
US

V. Phone/Fax

Practice location:
  • Phone: 858-642-1177
  • Fax: 858-642-6366
Mailing address:
  • Phone: 858-642-1177
  • Fax: 858-642-6366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number262542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: