Provider Demographics
NPI:1225416415
Name:CARLSEN, RONALD FOLMER
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:FOLMER
Last Name:CARLSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61698 257TH AVE
Mailing Address - Street 2:
Mailing Address - City:MANTORVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55955-6023
Mailing Address - Country:US
Mailing Address - Phone:507-282-8200
Mailing Address - Fax:
Practice Address - Street 1:61698 257 AVE
Practice Address - Street 2:
Practice Address - City:MANTORVILLE
Practice Address - State:MN
Practice Address - Zip Code:55955
Practice Address - Country:US
Practice Address - Phone:507-282-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4354171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor