Individual
SHANNON CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3311 RIVERBEND DR, SPRINGFIELD, OR 97477-8800
(541) 484-4332
(541) 302-0786
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 729-1459
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
201703390NP-PP
OR
363LA2100X
Acute Care Nurse Practitioner
ARNP 9380645
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013393500
—
FL
Enumeration date
08/18/2014
Last updated
07/21/2022
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