Provider Demographics
NPI:1508632563
Name:ANDERSON, CARLA MARIE (ND)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W BROADWAY ST STE 240
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2575
Mailing Address - Country:US
Mailing Address - Phone:989-600-0576
Mailing Address - Fax:
Practice Address - Street 1:113 W BROADWAY ST STE 240
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2575
Practice Address - Country:US
Practice Address - Phone:989-600-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV91104DTN175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath