1205164506 NPI number — AMY JANINE CARLSON RN, RD, CDE

Table of content: AMY JANINE CARLSON RN, RD, CDE (NPI 1205164506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205164506 NPI number — AMY JANINE CARLSON RN, RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLSON
Provider First Name:
AMY
Provider Middle Name:
JANINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, RD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN'T RIET
Provider Other First Name:
AMY
Provider Other Middle Name:
JANINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, RD, CDE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205164506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93160-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-681-1761
Provider Business Mailing Address Fax Number:
805-681-1176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 PESETAS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93110-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-681-1761
Provider Business Practice Location Address Fax Number:
805-681-1768
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WD0400X , with the licence number:  RN535155 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com