Provider Demographics
NPI:1548768211
Name:CARSON, DEMEREE (LPN)
Entity Type:Individual
Prefix:
First Name:DEMEREE
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21603 84TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7818
Mailing Address - Country:US
Mailing Address - Phone:425-431-7495
Mailing Address - Fax:
Practice Address - Street 1:21603 84TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7818
Practice Address - Country:US
Practice Address - Phone:425-431-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60241929164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse