Healthcare Provider Details

I. General information

NPI: 1326225731
Provider Name (Legal Business Name): CAROL JEAN AVERBECK RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 30TH ST SE
BUFFALO MN
55313-5335
US

IV. Provider business mailing address

12755 HIGHWAY 55 MN009-S130
PLYMOUTH MN
55441-3837
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-6716
  • Fax:
Mailing address:
  • Phone: 800-896-8936
  • Fax: 888-866-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR081347-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: