Healthcare Provider Details

I. General information

NPI: 1023086089
Provider Name (Legal Business Name): NICOLE A CARSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 YORK ROAD
BUCKINGHAM PA
18912
US

IV. Provider business mailing address

4897 YORK ROAD PO BOX 278
BUCKINGHAM PA
18912
US

V. Phone/Fax

Practice location:
  • Phone: 215-794-7471
  • Fax: 215-794-2576
Mailing address:
  • Phone: 215-794-7471
  • Fax: 215-794-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051781
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: