Individual
CARRIE DENISE MIKKELSON-HEREDIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
450 N ROXBURY DR, SUITE 600, BEVERLY HILLS, CA 90210-4232
(310) 651-2280
(310) 651-2260
Mailing address
450 N ROXBURY DR, SUITE 600, BEVERLY HILLS, CA 90210-4232
(310) 651-2280
(310) 651-2260
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
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