Individual
LORI CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 S 4TH ST, DHFS, ROOM 510, MINNEAPOLIS, MN 55415-1335
(612) 673-3548
(612) 673-3866
Mailing address
17810 24TH AVE N, PLYMOUTH, MN 55447-2108
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
094598-7
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12-03427
MEDICA
MN
05
—
251343900
—
MN
01
—
923911015067
PREFERRED ONE
MN
01
—
9L584CA
BCBS
MN
01
—
HP19846
HEALTH PARTNERS
MN
Enumeration date
03/29/2006
Last updated
07/08/2007
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