Provider Demographics
NPI:1609846989
Name:DREVLOW, CAROLYN (CFNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:DREVLOW
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:SHOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 CENTER CREEK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-3428
Mailing Address - Country:US
Mailing Address - Phone:507-238-4968
Mailing Address - Fax:
Practice Address - Street 1:1950 CENTER CREEK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-3428
Practice Address - Country:US
Practice Address - Phone:507-238-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1270800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN090K6DROtherBXBS
MN597432100Medicaid
MNP98358Medicare UPIN
MN090K6DROtherBXBS