Provider Demographics
NPI:1740544550
Name:CARLSON, ANGELA PATRICIA - GALEANO (CPSS/ CHW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:PATRICIA - GALEANO
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CPSS/ CHW
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPSS/ CHW
Mailing Address - Street 1:23910 OAK ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-2202
Mailing Address - Country:US
Mailing Address - Phone:313-562-8230
Mailing Address - Fax:
Practice Address - Street 1:23910 OAK ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-2202
Practice Address - Country:US
Practice Address - Phone:313-562-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker