| NPI | 1487883831 |
|---|---|
| Former Name | GINNY L CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.129996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11015167A) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2014-06-23 |