Provider Demographics
NPI:1639274335
Name:CARLSON, SUSAN MS (NPP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MS
Last Name:CARLSON
Suffix:
Gender:F
Credentials:NPP
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Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4395
Mailing Address - Fax:585-922-5715
Practice Address - Street 1:1425 PORTLAND AVE UNIT G1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3011
Practice Address - Country:US
Practice Address - Phone:585-922-4395
Practice Address - Fax:585-922-5715
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY400578363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health