Provider Demographics
NPI:1477723518
Name:CARLSON, JULIE ELIZABETH (CNM)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ELIZABETH
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 BRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-2660
Mailing Address - Country:US
Mailing Address - Phone:315-750-6978
Mailing Address - Fax:
Practice Address - Street 1:6403 BRIGGS RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-2660
Practice Address - Country:US
Practice Address - Phone:315-750-6978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1781176B00000X
CA17423363L00000X
NM629367A00000X
NYF001588-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMAAA2453Medicare PIN
NM15133061Medicaid