Provider Demographics
NPI:1467514661
Name:CARLSEN, EILEEN H (NP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:H
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PROSPECT ST
Mailing Address - Street 2:NANTUCKET PHYSICIANS CARE
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2799
Mailing Address - Country:US
Mailing Address - Phone:508-325-9981
Mailing Address - Fax:508-825-8133
Practice Address - Street 1:57 PROSPECT ST
Practice Address - Street 2:NANTUCKET PHYSICIANS CARE
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2799
Practice Address - Country:US
Practice Address - Phone:508-325-9981
Practice Address - Fax:508-825-8133
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333575-1363L00000X
MARN267156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02472902Medicaid
NYQ09687Medicare UPIN