Provider Demographics
NPI:1437186517
Name:CARLSON, PATRICIA ELIDA (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELIDA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 391
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-3113
Mailing Address - Fax:612-626-6601
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:347 NORTH SMITH AVENUE, SUITE 603
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 065532-9363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNB584OtherCHAMPUS
MNHP17676OtherHEALTHPARTNERS
IA0717850Medicaid
MT4305556Medicaid
WI43921200OtherWI MA
MN143409OtherUCARE
MN12-09026OtherMEDICA PRIMARY
MN2366356OtherARAZ
MN623T2CAOtherBCBS
MN1021569OtherPREFERRED ONE
MN12-03224OtherMEDICA CHOICE
MN623T2CAOtherBCBS