Healthcare Provider Details

I. General information

NPI: 1356634224
Provider Name (Legal Business Name): ANNA VENN CARLSON ELLASON DNP, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA VENN CARLSON DNP, RN, CNP

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E NICOLLET BLVD STE 250
BURNSVILLE MN
55337
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2960
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 172338-6
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR 172338-6
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4385-33
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number176645-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: