Provider Demographics
NPI:1417991167
Name:CARLSON, KAREN L (ARNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:CARLSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:4245 ROOSEVELT WAY NE
Practice Address - Street 2:BOX 354765
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6008
Practice Address - Country:US
Practice Address - Phone:206-598-5500
Practice Address - Fax:206-598-8722
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00074959163W00000X
WAAP30003179363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9633058Medicaid
WAUW2899OtherREGENCE BLUESHIELD
WAS74489Medicare UPIN
WAAB07787Medicare ID - Type UnspecifiedMEDICARE