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General NPI Number Information
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NPI Number | 1508320318
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Entity Type | Individual
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Provider Name | ANDREA CARLSON DVM
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Gender | Female
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 3570 E LINCOLN HWY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5830
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Country | US
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Telephone | 219-942-0909
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Fax | 219-942-0900
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Provider Business Mailing Address
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Address Line | 3570 E LINCOLN HWY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5830
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Country | US
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Telephone | 219-942-0909
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Fax | 219-942-0900
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 6165
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License Number State | IN
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