Healthcare Provider Details

I. General information

NPI: 1912987124
Provider Name (Legal Business Name): NICOLE LYNN CARLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 EASTLAND AVE SE FL 2
WARREN OH
44484-4503
US

IV. Provider business mailing address

667 EASTLAND AVE SE FL 2
WARREN OH
44484-4503
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4579
  • Fax: 330-841-4920
Mailing address:
  • Phone: 330-841-4579
  • Fax: 330-841-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD430168
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.154697
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28269
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0056758
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: