Provider Demographics
NPI:1730196056
Name:CARLBERG, NICOLE L (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:CARLBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2426 N MERRITT CREEK LOOP
Mailing Address - Street 2:STE A
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4961
Mailing Address - Country:US
Mailing Address - Phone:208-668-7000
Mailing Address - Fax:
Practice Address - Street 1:2426 N MERRITT CREEK LOOP STE A
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4961
Practice Address - Country:US
Practice Address - Phone:208-668-7000
Practice Address - Fax:208-665-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID-O-05922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry