Provider Demographics
NPI:1740468222
Name:CARSON, STEPHANIE ROSE (BSCN)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ROSE
Last Name:CARSON
Suffix:
Gender:F
Credentials:BSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DRUM HELLER RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:VT
Mailing Address - Zip Code:05065-6650
Mailing Address - Country:US
Mailing Address - Phone:802-763-2061
Mailing Address - Fax:
Practice Address - Street 1:5 ROPE FERRY RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1404
Practice Address - Country:US
Practice Address - Phone:603-646-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH044172-21163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health