Provider Demographics
NPI:1316178726
Name:CARLSON, DANNELLE J (ND)
Entity Type:Individual
Prefix:
First Name:DANNELLE
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:29414 NE BIG ROCK ROAD
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-1478
Mailing Address - Country:US
Mailing Address - Phone:425-788-1430
Mailing Address - Fax:206-260-3922
Practice Address - Street 1:29414 NE BIG ROCK RD
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-7337
Practice Address - Country:US
Practice Address - Phone:425-788-1430
Practice Address - Fax:206-260-3922
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine