Provider Demographics
NPI:1063112696
Name:CARLSON, ROXANNE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6259 ROUND TABLE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2652
Mailing Address - Country:US
Mailing Address - Phone:928-499-7302
Mailing Address - Fax:
Practice Address - Street 1:500 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313-5001
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN145588163WM0705X, 163WP0000X, 163WP2201X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care