Provider Demographics
NPI:1982206983
Name:CARLSON, DENISE LYNN
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 NATHAN DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2089
Mailing Address - Country:US
Mailing Address - Phone:330-357-9933
Mailing Address - Fax:
Practice Address - Street 1:983 NATHAN DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2089
Practice Address - Country:US
Practice Address - Phone:330-357-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care