Basic Information
| Provider Information | |||||||||
| NPI: | 1962841965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | ACKLEY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506011701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418472625 | ||||||||
| FaxNumber: | 6418472509 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 S OAK ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | IOWA FALLS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501269506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416487000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2013 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A118681 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.