Doctor Name: | MRS. JENNIFER M CARLSON |
NPI Number: | 1134251689 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 000589 |
Business Practice Address: | 999 Foxon Rd Suite 36 North Branford, CT - 064711287 |
Business Phone Number: | 2034847334 |
Business Fax Number: | 2034847301 |
Mailing Address: | 167 Old Sachems Head Rd, GUILFORD |
State: | CT |
Postal Code: | 064373136 |
Phone Number: | 2034847334 |
Fax Number: | 2034847301 |
NPI Enumeration Date: | 03/11/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 000589 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |