Provider Demographics
NPI:1740209469
Name:CARROLL, JAMES EARL (CRNA, APNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EARL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:CRNA, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5475
Mailing Address - Country:US
Mailing Address - Phone:715-284-8924
Mailing Address - Fax:715-284-7166
Practice Address - Street 1:711 W ADAMS ST
Practice Address - Street 2:C/O ANESTHESIA DEPARTMENT
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-9108
Practice Address - Country:US
Practice Address - Phone:715-284-5361
Practice Address - Fax:715-284-7166
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66410367500000X
MNR085903367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
29802OtherAANA CERTIFICATION NUMBER
WI43376100Medicaid
MNR085903OtherRN LICENSE NUMBER
WI0005OtherSEQUENCE NUMBER
WI66410OtherRN LICENSE NUMBER
WI1161OtherAPNP
29802OtherAANA CERTIFICATION NUMBER