Provider Demographics
NPI:1689902579
Name:CARLSON, NICHOLAS P (ARNP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:P
Last Name:CARLSON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 MARGUETTE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806
Mailing Address - Country:US
Mailing Address - Phone:563-326-5855
Mailing Address - Fax:563-326-4254
Practice Address - Street 1:3801 MARGUETTE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806
Practice Address - Country:US
Practice Address - Phone:563-326-5855
Practice Address - Fax:563-326-4254
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091795363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner