Individual
ELIZABETH M CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
370 N 120TH AVE, HOLLAND, MI 49424-2196
(616) 396-5855
(616) 396-5720
Mailing address
370 N 120TH AVE, HOLLAND, MI 49424-2196
(616) 396-5855
(616) 396-5720
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3404
WI
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316346752
—
MI
01
—
EB007542
BCBS
MI
Enumeration date
08/21/2014
Last updated
02/24/2020
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