Provider Demographics
NPI:1487650321
Name:CARLISLE, ANNE S (FNP-C)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:S
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 AIRPARK DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2433
Mailing Address - Country:US
Mailing Address - Phone:530-241-7098
Mailing Address - Fax:530-241-1483
Practice Address - Street 1:525 2ND ST
Practice Address - Street 2:SUITE 219
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-5107
Practice Address - Country:US
Practice Address - Phone:707-444-1331
Practice Address - Fax:707-444-1369
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP8560363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP8560OtherFNP LICENSE NUMBER
CANP8560OtherFNP LICENSE NUMBER
CAS62567Medicare UPIN