Provider Demographics
NPI:1467709964
Name:CARLSON, GLORIA DAWN (BA)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:DAWN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CIRBY HILLS DR
Mailing Address - Street 2:APARTMENT 221
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-4362
Mailing Address - Country:US
Mailing Address - Phone:415-900-9360
Mailing Address - Fax:
Practice Address - Street 1:300 CIRBY HILLS DR
Practice Address - Street 2:APARTMENT 221
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-4362
Practice Address - Country:US
Practice Address - Phone:415-900-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide