Healthcare Provider Details

I. General information

NPI: 1598034845
Provider Name (Legal Business Name): MARGARET LYDIA CARLSON FITZTHUM RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARGARET LYDIA CARLSON

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-3000
  • Fax:
Mailing address:
  • Phone: 612-873-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number169610-9
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number169610-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: