Individual
KELLY JEAN STAUSS CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1000 SOUTH COLUMBIA ROAD, GRAND FORKS, ND 58206-6002
(701) 780-5000
(701) 235-2099
Mailing address
PO BOX 6002, GRAND FORKS, ND 58206-6002
(701) 780-5000
(701) 235-2099
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R28140
ND
Other
Enumeration date
08/24/2011
Last updated
10/25/2012
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