Colette Susanne Carlsen, RN
Individual provider Active NPI Registered Nurse · Bad Axe, MI
NPI 1104593482 · NPPES record last updated Aug 25, 2021
Key facts
- NPI
- 1104593482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 4704353955 (MI)
- Practice address
- 1375 R Dale Wertz Dr
Bad Axe, MI 48413-1365 - Phone
- (989) 269-9293
- NPI assigned
- Aug 25, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704353955 | MI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704353955 | MI | Yes |
Addresses
Primary practice location
1375 R Dale Wertz Dr
Bad Axe, MI 48413-1365
Mailing address
1375 R Dale Wertz Dr
Bad Axe, MI 48413-1365
Phone (989) 269-9293
Other providers in Bad Axe, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.