Individual
ANDREW CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
2301 25TH ST S, FARGO, ND 58103
(701) 417-6000
Mailing address
1920 21ST AVE S, APT 308, FARGO, ND 58103
(701) 317-1473
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
536-14
ND
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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