Individual
MR. RICHARD B CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
111 S FRONT ST, HARRISBURG, PA 17101-2010
(717) 782-5118
(717) 782-5854
Mailing address
409 S 2ND ST, SUITE 2F, HARRISBURG, PA 17104-1612
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN293081L
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN293081L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659253
BLUE SHIELD
—
Enumeration date
06/07/2006
Last updated
12/19/2017
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