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General NPI Number Information
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NPI Number | 1497109730
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Entity Type | Individual
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Provider Name | DUSTIN DANIEL CARLSON FNP
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Gender | Male
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/07/2026
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Provider Practice Location Address
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Address Line | 80 SE MADISON ST STE 150
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City | PORTLAND
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State | OR
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Zip | 97214-4527
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Country | US
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Telephone | 971-449-7320
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Fax |
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Provider Business Mailing Address
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Address Line | 80 SE MADISON ST STE 150
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City | PORTLAND
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State | OR
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Zip | 97214-4527
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Country | US
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Telephone | 971-449-7320
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Fax | 949-989-8079
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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 | 340594
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201702479NP-PP
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License Number State | OR
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