Healthcare Provider Details

I. General information

NPI: 1699174805
Provider Name (Legal Business Name): ELIZABETH MARY CARLSON CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 JEFFERSON ST NE STE 350
ALBUQUERQUE NM
87109-4361
US

IV. Provider business mailing address

6801 JEFFERSON ST NE STE 350
ALBUQUERQUE NM
87109-4361
US

V. Phone/Fax

Practice location:
  • Phone: 505-847-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number661
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02462
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: