Provider Demographics
NPI:1841476918
Name:CARLSTROM, SUSAN (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CARLSTROM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:WAUNA
Mailing Address - State:WA
Mailing Address - Zip Code:98395-0597
Mailing Address - Country:US
Mailing Address - Phone:253-853-4656
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00117308163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health