Provider Demographics
NPI:1811291628
Name:BOHRER, CARSON FRANK
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:FRANK
Last Name:BOHRER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 KATHY WAY
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8771
Mailing Address - Country:US
Mailing Address - Phone:916-660-9871
Mailing Address - Fax:
Practice Address - Street 1:3257 KATHY WAY
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8771
Practice Address - Country:US
Practice Address - Phone:916-660-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232686164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse