Healthcare Provider Details

I. General information

NPI: 1932115748
Provider Name (Legal Business Name): CAROL ARLENE DETTMANN RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S COLORADO ST STE A
LOCKHART TX
78644-2707
US

IV. Provider business mailing address

10802 MARBLE RD
AUSTIN TX
78750-1516
US

V. Phone/Fax

Practice location:
  • Phone: 512-376-9690
  • Fax: 512-398-3755
Mailing address:
  • Phone: 512-773-9652
  • Fax: 512-398-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235807
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: