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NPI Code Detail

MEDICARE: CAROL JOAN PEITZMAN APRN, CNS

MEDICARE: CAROL JOAN PEITZMAN APRN, CNS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0809XAdult Psychiatric/Mental Health Clinical Nurse Specialist240MN

General Provider Information

NPI Number : 1225120991
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL JOAN PEITZMAN APRN, CNS
Provider Business Mailing Address
First Line : 3200 LABORE RD STE 104
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55110-5186
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 4TH ST NW
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-5089
Country : US
Telephone Number : 507-384-6830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2006
Last Update Date : 01/10/2025

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