Provider Demographics
NPI:1447217849
Name:CARLSON, JANNA K (MD)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:K
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:
Other - Last Name:CARLSON-DONOHUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1313 PENN AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411
Mailing Address - Country:US
Mailing Address - Phone:612-543-2500
Mailing Address - Fax:612-302-4870
Practice Address - Street 1:1313 PENN AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411
Practice Address - Country:US
Practice Address - Phone:612-543-2500
Practice Address - Fax:612-302-4870
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00288800Medicaid
MN00288800Medicaid
080012233Medicare ID - Type Unspecified