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General NPI Number Information
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NPI Number | 1528894383
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Entity Type | Individual
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Provider Name | DENITA CARSON CHW
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Gender | Female
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 409 TALMAGE RD
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City | UKIAH
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State | CA
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Zip | 95482-5956
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Country | US
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Telephone | 707-234-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 415 WASHO DR
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City | UKIAH
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State | CA
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Zip | 95482-5136
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Country | US
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Telephone | 707-272-5873
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | D3943985
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License Number State | CA
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