Provider Demographics
NPI:1003872029
Name:SWEETRA, CARLA M (NP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:SWEETRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:M
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1785 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3318
Mailing Address - Country:US
Mailing Address - Phone:978-683-0526
Mailing Address - Fax:
Practice Address - Street 1:50 PROSPECT ST
Practice Address - Street 2:SUITE 505
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2841
Practice Address - Country:US
Practice Address - Phone:978-794-8119
Practice Address - Fax:978-794-9912
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236496NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP5303Medicare ID - Type Unspecified
MANP530302Medicare PIN
MANP530303Medicare PIN
Q66291Medicare UPIN