Healthcare Provider Details

I. General information

NPI: 1588067433
Provider Name (Legal Business Name): DARA DELNORA CARLSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 ROOSEVELT WAY NE FL 3
SEATTLE WA
98105-6008
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-8750
  • Fax:
Mailing address:
  • Phone: 206-543-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP 60506846
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: