Provider Demographics
NPI:1568425056
Name:CARLSON, CATHERINE (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CRISTY COURT
Mailing Address - Street 2:
Mailing Address - City:N SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896
Mailing Address - Country:US
Mailing Address - Phone:401-769-8207
Mailing Address - Fax:
Practice Address - Street 1:11 CRISTY COURT
Practice Address - Street 2:
Practice Address - City:N SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896
Practice Address - Country:US
Practice Address - Phone:401-769-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239185367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered