NPI | 1356634224 |
---|---|
Former Name | ANNA VENN CARLSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2960) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 172338-6) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R 172338-6) | |
363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 4385-33) | |
163W00000X Registered Nurse (Licence: WI 176645-30) | |
Enumeration Date | 2011-05-25 |
Last Update Date | 2022-11-01 |