Individual
KATHLEEN A CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
761 45TH ST STE 103, MUNSTER, IN 46321-2899
(219) 922-3002
(219) 922-3003
Mailing address
1613 SONOMA CT, CROWN POINT, IN 46307-3748
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
71000108A
IN
363L00000X
Nurse Practitioner
71000108
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
071000108A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200062110
—
IN
05
—
200062110A
—
IN
Enumeration date
06/14/2006
Last updated
03/08/2023
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