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General NPI Number Information
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NPI Number | 1033311451
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Entity Type | Individual
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Provider Name | SUSAN L CARLSON MS, APRN-C, NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1945 WESTWOOD HL
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City | CASPER
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State | WY
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Zip | 82604-3266
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Country | US
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Telephone | 307-234-1669
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Fax |
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Provider Business Mailing Address
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Address Line | 321 BLUFFVIEW RD
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City | WHEATLAND
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State | WY
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Zip | 82201-9224
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Country | US
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Telephone | 307-760-1640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22106.0898
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License Number State | WY
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