Healthcare Provider Details

I. General information

NPI: 1871653535
Provider Name (Legal Business Name): TANA DENISE CARLSON PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH STREET SE WOODLAND CENTERS
WILLMAR MN
56201-4675
US

IV. Provider business mailing address

5340 15TH AVE SW
WILLMAR MN
56201
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-9148
  • Fax: 320-231-9140
Mailing address:
  • Phone: 320-235-4613
  • Fax: 320-231-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: