Healthcare Provider Details

I. General information

NPI: 1356517031
Provider Name (Legal Business Name): MARILYNN ELIZABETH CARLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 NE 55TH AVE
VANCOUVER WA
98661-7800
US

IV. Provider business mailing address

5601 NE 55TH AVE
VANCOUVER WA
98661-7800
US

V. Phone/Fax

Practice location:
  • Phone: 360-735-9998
  • Fax:
Mailing address:
  • Phone: 360-735-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC10090039
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00177479
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: