Basic Information
| Provider Information | |||||||||
| NPI: | 1437186517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ELIDA | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 420 DELAWARE STREET SE, MMC 391 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126243113 | ||||||||
| FaxNumber: | 6126266601 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 347 NORTH SMITH AVENUE, SUITE 603 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512206760 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R 065532-9 | MN | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0200X | R 065532-9 | MN | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | B584 | 01 | MN | CHAMPUS | OTHER | HP17676 | 01 | MN | HEALTHPARTNERS | OTHER | 0717850 | 05 | IA | MEDICAID | 4305556 | 05 | MT | MEDICAID | 43921200 | 01 | WI | WI MA | OTHER | 143409 | 01 | MN | UCARE | OTHER | 12-09026 | 01 | MN | MEDICA PRIMARY | OTHER | 2366356 | 01 | MN | ARAZ | OTHER | 623T2CA | 01 | MN | BCBS | OTHER | 1021569 | 01 | MN | PREFERRED ONE | OTHER | 12-03224 | 01 | MN | MEDICA CHOICE | OTHER |