Provider Demographics
NPI:1568817096
Name:CARLSON, AMY LEA
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12820 GREENWOOD FOREST DR
Mailing Address - Street 2:APT 519
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-1636
Mailing Address - Country:US
Mailing Address - Phone:832-312-0006
Mailing Address - Fax:
Practice Address - Street 1:12820 GREENWOOD FOREST DR
Practice Address - Street 2:APT 519
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-1636
Practice Address - Country:US
Practice Address - Phone:832-312-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic