Provider Demographics
NPI:1750909156
Name:CARLSON, HILLARY (LVN)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4651 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3642
Mailing Address - Country:US
Mailing Address - Phone:619-318-4571
Mailing Address - Fax:
Practice Address - Street 1:4651 36TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-3642
Practice Address - Country:US
Practice Address - Phone:619-318-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-12
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281952164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty