Provider Demographics
NPI:1558042036
Name:CARLSON, JACQUELINE MARGARET (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARGARET
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 VASSAR PL
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1321
Mailing Address - Country:US
Mailing Address - Phone:516-887-0305
Mailing Address - Fax:
Practice Address - Street 1:45 VASSAR PL
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1321
Practice Address - Country:US
Practice Address - Phone:516-887-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592527163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice