Provider Demographics
NPI:1376729178
Name:CARLSON, DARLENE EVELYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:EVELYN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5577 MILLER TRUNK HWY
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1233
Mailing Address - Country:US
Mailing Address - Phone:218-729-5304
Mailing Address - Fax:218-729-8164
Practice Address - Street 1:5577 MILLER TRUNK HWY
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1233
Practice Address - Country:US
Practice Address - Phone:218-729-5304
Practice Address - Fax:218-729-8164
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-075305-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse