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General NPI Number Information
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NPI Number | 1124195821
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Entity Type | Individual
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Provider Name | SUSAN LOANN CARLSON NP
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7400 MERTON MINTER ST
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4404
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Country | US
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Telephone | 210-949-3248
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Fax |
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Provider Business Mailing Address
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Address Line | 17306 FOUNTAIN VW
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City | SAN ANTONIO
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State | TX
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Zip | 78248-1938
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Country | US
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Telephone | 210-479-2100
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 614651
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 364SM0705X
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Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
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License Number | 614651
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License Number State | TX
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