Provider Demographics
NPI:1700184843
Name:CARLSON, VICKI J (RN,IBCLC,RLC,LCCE)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RN,IBCLC,RLC,LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 NE 54TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-4905
Mailing Address - Country:US
Mailing Address - Phone:910-201-4624
Mailing Address - Fax:
Practice Address - Street 1:308 NE 54TH ST
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-4905
Practice Address - Country:US
Practice Address - Phone:910-201-4624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-13
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC180070163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant