Provider Demographics
NPI:1861726283
Name:MATTHIASSON, CAROLYN WEESNER (CERTIFIED DOULA)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:WEESNER
Last Name:MATTHIASSON
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 E PATRICIA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1613
Mailing Address - Country:US
Mailing Address - Phone:520-322-9186
Mailing Address - Fax:
Practice Address - Street 1:4434 E PATRICIA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1613
Practice Address - Country:US
Practice Address - Phone:520-322-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ374J00000X374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula