Individual
MRS. SUSAN RENEE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, ANP
Contact information
Practice address
2740 N HWY 360, SUITE 100, GRAND PRAIRIE, TX 75050-6403
(972) 606-8300
(972) 606-4940
Mailing address
2740 N HWY 360, SUITE 100, GRAND PRAIRIE, TX 75050-6403
(972) 606-8300
(972) 606-4940
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
565581
TX
363LA2200X
Adult Health Nurse Practitioner
Primary
565581
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156976601
—
TX
Enumeration date
05/25/2006
Last updated
02/23/2010
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