MEDICARE: MS. CARLA SYVERSON CNM, ARNP

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	367A00000X	Advanced Practice Midwife	AP30006531	WA
2	367A00000X	Advanced Practice Midwife	RN075370 CNM	GA

General Provider Information

NPI Number	:	1841295110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA SYVERSON CNM, ARNP

Provider Business Mailing Address
First Line	:	2623 206TH AVENUE CT E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-9307
Country	:	US
Telephone Number	:	253-826-5637
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 206TH AVENUE CT E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-9307
Country	:	US
Telephone Number	:	253-826-5637
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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