Provider Demographics
NPI:1689849838
Name:CARLSON, JEAN MARIE
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24765 HEARTLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEVIS
Mailing Address - State:MN
Mailing Address - Zip Code:56467
Mailing Address - Country:US
Mailing Address - Phone:218-652-3146
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVE N
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1054
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:318-998-3187
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0579272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse