Provider Demographics
NPI:1588003107
Name:CARLSON, ANNA GERTRUIDA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:GERTRUIDA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 STOCKTON BLVD.
Mailing Address - Street 2:PEDIATRIC RESIDENCY PROGRAM
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-2428
Mailing Address - Fax:
Practice Address - Street 1:2516 STOCKTON BLVD.
Practice Address - Street 2:PEDIATRIC RESIDENCY PROGRAM
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program