Healthcare Provider Details

I. General information

NPI: 1831338664
Provider Name (Legal Business Name): JOYCE LORRAINE CARLSON RN, ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S SIBLEY AVE
LITCHFIELD MN
55355-3340
US

IV. Provider business mailing address

612 S SIBLEY AVE
LITCHFIELD MN
55355-3340
US

V. Phone/Fax

Practice location:
  • Phone: 320-693-4576
  • Fax: 320-693-4567
Mailing address:
  • Phone: 320-693-4576
  • Fax: 320-693-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR079234-7
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberR079234-7
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License NumberR079234-7
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR079234-7
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2008004436
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: