Individual
CARRIE DENISE MIKKELSON-HEREDIA
Active
Individual
CARRIE DENISE MIKKELSON-HEREDIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3288
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074093
CCNA CERTIFICATION
CA
01
—
3288
NURSE ANESTHETIST
CA
01
—
508419
STATE LICENSE NURSE
CA
Enumeration date
11/22/2006
Last updated
07/16/2015
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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