Provider Demographics
NPI:1861552010
Name:VOSSEN, CARLA M (FNP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:VOSSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MARTIN AVE W
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54889-9069
Mailing Address - Country:US
Mailing Address - Phone:715-986-4101
Mailing Address - Fax:
Practice Address - Street 1:550 MARTIN AVE W
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889-9069
Practice Address - Country:US
Practice Address - Phone:715-986-4101
Practice Address - Fax:715-986-4033
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450094NP FNP PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36056700Medicaid
WI3334-33OtherWISCONSIN APNP LICENSE
WI105858-30OtherWIS RN LICENSE
WI32862100 PROV GROUPMedicaid
WIGROUP 00496Medicare PIN
WI3334-33OtherWISCONSIN APNP LICENSE
WIQ27064Medicare UPIN