Healthcare Provider Details

I. General information

NPI: 1639693369
Provider Name (Legal Business Name): CARLY A COMPTON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

3870 GLACIER PL N
PLYMOUTH MN
55446-3334
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-2955
  • Fax: 612-873-2955
Mailing address:
  • Phone: 763-229-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberR179799-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: