Provider Demographics
NPI:1578886198
Name:CARLSON, ANDREA J (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:J
Last Name:CARLSON
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 1:179 HIGH ACRES
Mailing Address - Street 2:
Mailing Address - City:BEMUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14712-9798
Mailing Address - Country:US
Mailing Address - Phone:716-484-0508
Mailing Address - Fax:
Practice Address - Street 1:220 FLUVANNA AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2051
Practice Address - Country:US
Practice Address - Phone:716-487-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252712164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse