Provider Demographics
NPI:1023824422
Name:CARLSON, NICOLE ASHLEY
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ASHLEY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ASHLEY
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PIERCE
Mailing Address - State:NE
Mailing Address - Zip Code:68767-1203
Mailing Address - Country:US
Mailing Address - Phone:402-841-7906
Mailing Address - Fax:
Practice Address - Street 1:221 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PIERCE
Practice Address - State:NE
Practice Address - Zip Code:68767-1203
Practice Address - Country:US
Practice Address - Phone:402-841-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care