Individual
MRS. CARLY ANNE BRONSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N., NP
Contact information
Practice address
41820 GARSTIN DR., BIG BEAR LAKE, CA 92315
(909) 878-8246
(909) 878-8294
Mailing address
PO BOX 1649, BIG BEAR LAKE, CA 92315-1649
(909) 878-8246
(909) 878-8294
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
101-0033221
VT
363LF0000X
Family Nurse Practitioner
060326-23
NH
363LF0000X
Family Nurse Practitioner
Primary
95001879
CA
363LF0000X
Family Nurse Practitioner
COA.12102-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013302
—
OH
05
—
1013302
—
VT
05
—
19626228719
—
VT
Enumeration date
04/18/2007
Last updated
08/03/2023
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