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General NPI Number Information
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NPI Number | 1366751059
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Entity Type | Individual
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Provider Name | VERONICA LYNN CARSON GNP-BG
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Gender | Female
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 4195 WESTBERG RD APT 436
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City | HERMANTOWN
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State | MN
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Zip | 55811-3888
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Country | US
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Telephone | 701-516-4637
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Fax | 877-651-1381
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Provider Business Mailing Address
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Address Line | 2965 E TARPON DR STE 150
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City | MERIDIAN
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State | ID
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Zip | 83642-9007
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Country | US
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Telephone | 208-287-9420
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Fax | 208-287-9426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 1294
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R-175893-7
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License Number State | MN
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