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Individual

PAMELA JEANNE CARLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1010 SPRUCE ST, ESPANOLA, NM 87532-2724
(505) 753-7111
Mailing address
10B ABS RD, SANTA FE, NM 87506-7906
(949) 235-6080

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R53755
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
73839370
NM
Enumeration date
07/14/2006
Last updated
07/08/2007
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