Provider Demographics
NPI:1689074619
Name:CARSON, MABEL E (FNP-C)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:E
Last Name:CARSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MABEL
Other - Middle Name:E
Other - Last Name:CASAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26276 CRESTHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4138
Mailing Address - Country:US
Mailing Address - Phone:423-208-4528
Mailing Address - Fax:
Practice Address - Street 1:980 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3520
Practice Address - Country:US
Practice Address - Phone:909-521-7508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5745363LF0000X
CA95002376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily