Individual
MRS. GLENICE M CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
510 4TH ST S, PRAIRIE ST JOHNS, FARGO, ND 58103
(701) 476-7239
(701) 280-5798
Mailing address
2320 124 AVE S, HORACE, ND 58047
(701) 476-7239
(701) 280-5798
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0129
ND
Other
Enumeration date
09/07/2006
Last updated
07/08/2007
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