Provider Demographics
NPI:1801003751
Name:CARLSON, ANNA FAY (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:FAY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 STUDEBAKER DR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8844
Mailing Address - Country:US
Mailing Address - Phone:509-954-8790
Mailing Address - Fax:
Practice Address - Street 1:1211 STUDEBAKER DR
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8844
Practice Address - Country:US
Practice Address - Phone:509-954-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006588174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist