Individual
MR. JAMES EARL CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA, APNP
Contact information
Practice address
711 W ADAMS ST, C/O ANESTHESIA DEPARTMENT, BLACK RIVER FALLS, WI 54615-9108
(715) 284-5361
(715) 284-7166
Mailing address
1383 SKYLINE DRIVE, WINONA, MN 55987-5475
(715) 284-8924
(715) 284-7166
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
66410
WI
367500000X
Certified Registered Nurse Anesthetist
R085903
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005
SEQUENCE NUMBER
WI
01
—
1161
APNP
WI
01
—
29802
AANA CERTIFICATION NUMBER
—
05
—
43376100
—
WI
01
—
66410
RN LICENSE NUMBER
WI
01
—
R085903
RN LICENSE NUMBER
MN
Enumeration date
07/19/2006
Last updated
07/08/2007
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