Provider Demographics
NPI:1770879751
Name:CARLSON, MARIAN V (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:V
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8164 STATE HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-9042
Mailing Address - Country:US
Mailing Address - Phone:715-219-3211
Mailing Address - Fax:
Practice Address - Street 1:1675 SEMINOLE TRL
Practice Address - Street 2:
Practice Address - City:SAINT GERMAIN
Practice Address - State:WI
Practice Address - Zip Code:54558-9032
Practice Address - Country:US
Practice Address - Phone:715-542-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22788164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse