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Individual

DOREEN CARSON IV

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2800 CLEVELAND AVE N, ROSEVILLE, MN 55113-1126
(651) 642-1825
Mailing address
6470 -236 ST CT N, FOREST LAKE, MN 55025

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R121681-9
MN
163W00000X
Registered Nurse
WI

Other

Enumeration date
02/15/2007
Last updated
07/08/2007
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