Individual
MRS. HEIDI JO CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
446 OAK ST / 6579, BROOKINGS, OR 97415-0285
(541) 412-8898
(541) 412-7420
Mailing address
PO BOX 6579, 446 OAK ST / 6579, BROOKINGS, OR 97415-0285
(541) 412-8898
(541) 412-7420
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200150156
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100122
—
OR
Enumeration date
07/18/2005
Last updated
09/08/2014
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