Provider Demographics
NPI:1023286846
Name:HYLDAHL, CARRIE D (LMP, EOT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:D
Last Name:HYLDAHL
Suffix:
Gender:F
Credentials:LMP, EOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 12TH ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2413
Mailing Address - Country:US
Mailing Address - Phone:425-273-4911
Mailing Address - Fax:425-374-8857
Practice Address - Street 1:8713 12TH ST NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2413
Practice Address - Country:US
Practice Address - Phone:425-273-4911
Practice Address - Fax:425-374-8857
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022633171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor