Provider Demographics
NPI:1598428922
Name:CARLSEN, ANNETTE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 E. WASHINGTON BLVD
Mailing Address - Street 2:C SUITE 101
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8397
Mailing Address - Country:US
Mailing Address - Phone:707-464-6715
Mailing Address - Fax:707-464-8988
Practice Address - Street 1:780 E. WASHINGTON BLVD
Practice Address - Street 2:C SUITE 101
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8397
Practice Address - Country:US
Practice Address - Phone:707-464-6715
Practice Address - Fax:707-464-8988
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program