Individual
ELISA DEN OUTER CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
128 LIBRARY HILL LN, LEXINGTON, SC 29072-3893
(803) 520-5940
Mailing address
128 LIBRARY HILL LN, LEXINGTON, SC 29072-3893
(803) 520-5940
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
27372
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/28/2022
Last updated
06/27/2023
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