Individual
THERESA CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 WESTERN AVE, MANITOWOC, WI 54220-3712
(920) 320-2011
Mailing address
6925 IRISH RD, TWO RIVERS, WI 54241-9542
(414) 324-7502
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
239835-30
WI
363LF0000X
Family Nurse Practitioner
000000
WI
Other
Enumeration date
02/13/2023
Last updated
02/13/2023
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