Provider Demographics
NPI:1578626198
Name:CLOUD, CARLENE KAY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:KAY
Last Name:CLOUD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W CHANNING AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2730
Mailing Address - Country:US
Mailing Address - Phone:218-739-7377
Mailing Address - Fax:
Practice Address - Street 1:1400 N UNION AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1248
Practice Address - Country:US
Practice Address - Phone:218-739-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 125406-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103542800OtherMHCP