Provider Demographics
NPI:1932115748
Name:DETTMANN, CAROL ARLENE (RN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ARLENE
Last Name:DETTMANN
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 MARBLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1516
Mailing Address - Country:US
Mailing Address - Phone:512-773-9652
Mailing Address - Fax:512-398-3755
Practice Address - Street 1:300 S COLORADO ST STE A
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2707
Practice Address - Country:US
Practice Address - Phone:512-376-9690
Practice Address - Fax:512-398-3755
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily