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Individual

MS. WENDY MARIE CARLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
21 SHORE RD, BERKLEY, MA 02779-2324
(774) 501-1440
(508) 967-7304
Mailing address
21 SHORE RD, BERKLEY, MA 02779-2324
(774) 501-1440
(508) 967-7304

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
230033
MA
163W00000X
Registered Nurse
48702
RI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN01440
RI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN230033
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
APRN01440
APRN
RI
01
MC4398120
CONTROLLED SUBSTANCE REGISTRATION
MA
01
RN230033
APRN
MA
05
S400325789
MA
Enumeration date
03/31/2016
Last updated
08/14/2020
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