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General NPI Number Information
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NPI Number | 1578481099
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Entity Type | Individual
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Provider Name | JAKE ALEXANDER CARLSON
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Gender | Male
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 07/10/2026
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Provider Practice Location Address
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Address Line | 140 NUTT RD
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-3900
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Country | US
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Telephone | 610-983-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2799 SPRINGHAVEN PL
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City | MACUNGIE
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State | PA
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Zip | 18062-1410
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Country | US
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Telephone | 908-565-1508
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN712653
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License Number State | PA
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