Provider Demographics
NPI:1104036474
Name:CARLSON, JEANNOT LEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNOT
Middle Name:LEE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:599 SIR FRANCIS DRAKE BLVD STE 202
Mailing Address - Street 2:SUITE 117
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1731
Mailing Address - Country:US
Mailing Address - Phone:415-461-1149
Mailing Address - Fax:415-925-1156
Practice Address - Street 1:599 SIR FRANCIS DRAKE BLVD STE 202
Practice Address - Street 2:SUITE 117
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1731
Practice Address - Country:US
Practice Address - Phone:415-461-1149
Practice Address - Fax:415-925-1156
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA209664363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health