Provider Demographics
NPI:1295108603
Name:CARLSON, ALLIE FRANCES (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALLIE
Middle Name:FRANCES
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ALLIE
Other - Middle Name:FRANCES
Other - Last Name:METZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1025 MARSH STREET
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:920-609-9623
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH STREET
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:076-254-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant