Provider Demographics
NPI:1013715572
Name:DAHLSTEDT-HENDERSON, CARLIE RENEE (RN, BSN)
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:RENEE
Last Name:DAHLSTEDT-HENDERSON
Suffix:
Gender:
Credentials:RN, BSN
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:RENEE
Other - Last Name:REYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-1300
Mailing Address - Country:US
Mailing Address - Phone:410-474-0531
Mailing Address - Fax:
Practice Address - Street 1:3300 KAREN DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3853
Practice Address - Country:US
Practice Address - Phone:410-474-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR266009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse