Provider Demographics
NPI:1841295110
Name:SYVERSON, CARLA (CNM, ARNP)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:
Last Name:SYVERSON
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 206TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-9307
Mailing Address - Country:US
Mailing Address - Phone:253-826-5637
Mailing Address - Fax:
Practice Address - Street 1:2623 206TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-9307
Practice Address - Country:US
Practice Address - Phone:253-826-5637
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006531367A00000X
GARN075370 CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife