Provider Demographics
NPI:1982346565
Name:CARSON, ANDREW SCOTT (LVN)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:CARSON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SANTA RITA PL
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-1948
Mailing Address - Country:US
Mailing Address - Phone:951-797-3166
Mailing Address - Fax:
Practice Address - Street 1:532 SANTA RITA PL
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-1948
Practice Address - Country:US
Practice Address - Phone:951-797-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA684904164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse