Provider Demographics
NPI:1245625664
Name:CARLSON, CATHERINE MARY (APRN, CPNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 COUNTY ROAD B2 W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2729
Mailing Address - Country:US
Mailing Address - Phone:651-636-4155
Mailing Address - Fax:
Practice Address - Street 1:1935 COUNTY ROAD B2 W
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2729
Practice Address - Country:US
Practice Address - Phone:651-636-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 3804363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics