Doctor Name: | MRS. SHERIDA CARLSON |
NPI Number: | 1225107667 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | 1994 |
Business Practice Address: | 108 S Broad St Globe, AZ - 855012602 |
Business Phone Number: | 9284256592 |
Business Fax Number: | 9284257655 |
Mailing Address: | Po Box 1508, CLAYPOOL |
State: | AZ |
Postal Code: | 855321508 |
Phone Number: | 9284020952 |
Fax Number: | 9284257566 |
NPI Enumeration Date: | 11/08/2006 |
NPI Last Update Date: | 02/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1994 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |