Provider Demographics
NPI:1831338664
Name:CARLSON, JOYCE LORRAINE (RN, ACNS-BC)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:LORRAINE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S SIBLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-3340
Mailing Address - Country:US
Mailing Address - Phone:320-693-4576
Mailing Address - Fax:320-693-4567
Practice Address - Street 1:612 S SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-3340
Practice Address - Country:US
Practice Address - Phone:320-693-4576
Practice Address - Fax:320-693-4567
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR079234-7163WW0000X, 163WX1500X, 163WC2100X, 163W00000X
MN2008004436364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163W00000XNursing Service ProvidersRegistered Nurse