MEDICARE: DENITA CARSON CHW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	D3943985	CA

General Provider Information

NPI Number	:	1528894383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENITA CARSON CHW

Provider Business Mailing Address
First Line	:	415 WASHO DR
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-5136
Country	:	US
Telephone Number	:	707-272-5873
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 TALMAGE RD
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-5956
Country	:	US
Telephone Number	:	707-234-0086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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Directions to “ DENITA CARSON CHW” Practice Location

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