Provider Demographics
NPI:1326225731
Name:AVERBECK, CAROL JEAN (RN, CNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:AVERBECK
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12755 HIGHWAY 55
Mailing Address - Street 2:MN009-S130
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3837
Mailing Address - Country:US
Mailing Address - Phone:800-896-8936
Mailing Address - Fax:888-866-3209
Practice Address - Street 1:1164 30TH ST SE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-5335
Practice Address - Country:US
Practice Address - Phone:763-682-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR081347-5363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily