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General NPI Number Information
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NPI Number | 1114646999
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Entity Type | Individual
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Provider Name | DANIELLE MARIE CARLSON APRN
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Gender | Female
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 3125 E MERIDIAN PARK LOOP STE 200
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City | WASILLA
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State | AK
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Zip | 99654-7528
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Country | US
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Telephone | 907-561-3211
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Fax |
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Provider Business Mailing Address
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Address Line | 3841 PIPER ST STE T100
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City | ANCHORAGE
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State | AK
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Zip | 99508-4674
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Country | US
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Telephone | 907-561-3211
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 197375
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License Number State | AK
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