Provider Demographics
NPI:1750892741
Name:CARLSON, MARIE MCDERMOTT (DNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:MCDERMOTT
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 SANTA MONICA BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4496
Mailing Address - Country:US
Mailing Address - Phone:909-962-1260
Mailing Address - Fax:
Practice Address - Street 1:8550 SANTA MONICA BLVD FL 2
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4496
Practice Address - Country:US
Practice Address - Phone:909-962-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPAN313363LF0000X
WY47645363LF0000X
NH084907-23363LF0000X
ID68512363LF0000X
NYF347968-01363LF0000X
IAA168159363LF0000X
HIAPRN-3283363LF0000X
VA0024175214363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily