Provider Demographics
NPI:1508320318
Name:CARLSON, ANDREA (DVM)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5830
Mailing Address - Country:US
Mailing Address - Phone:219-942-0909
Mailing Address - Fax:219-942-0900
Practice Address - Street 1:3570 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5830
Practice Address - Country:US
Practice Address - Phone:219-942-0909
Practice Address - Fax:219-942-0900
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN6165174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist