Provider Demographics
NPI:1033311451
Name:CARLSON, SUSAN L (MS, APRN-C, NP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS, APRN-C, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BLUFFVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-9224
Mailing Address - Country:US
Mailing Address - Phone:307-760-1640
Mailing Address - Fax:
Practice Address - Street 1:1945 WESTWOOD HL
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3266
Practice Address - Country:US
Practice Address - Phone:307-234-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22106.0898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily