Provider Demographics
NPI:1205413994
Name:CARLSON, SHOSHANNAH ROSE (CNP, FNP)
Entity Type:Individual
Prefix:
First Name:SHOSHANNAH
Middle Name:ROSE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CNP, FNP
Other - Prefix:
Other - First Name:SHOSHANNAH
Other - Middle Name:ROSE
Other - Last Name:POOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4521 HAMPSHIRE AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-5135
Mailing Address - Country:US
Mailing Address - Phone:612-578-6100
Mailing Address - Fax:
Practice Address - Street 1:6452 CITY WEST PKWY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3245
Practice Address - Country:US
Practice Address - Phone:952-999-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily