Individual
MISS RENEE MARIE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
425 PINE RIDGE BLVD STE 211, WAUSAU, WI 54401-4123
(715) 845-5505
(715) 848-2884
Mailing address
425 PINE RIDGE BLVD STE 211, WAUSAU, WI 54401-4123
(715) 845-5505
(715) 848-2884
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
148002030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356596415
—
WI
01
—
213050061
WPS MEDICARE
WI
Enumeration date
11/17/2008
Last updated
08/25/2009
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