Active NPI
Lori Carlson
- Pediatric Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1114988318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 094598-7
- Practice address
- 250 S 4TH St
DHFS, Room 510
Minneapolis, MN 55415-1335 - Phone
- (612) 673-3548
- Fax
- (612) 673-3866
- NPI assigned
- Mar 29, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 094598-7 | MN | Primary |
Addresses
Primary practice location
250 S 4TH St
DHFS, Room 510
Minneapolis, MN 55415-1335
Mailing address
17810 24TH Ave N
Plymouth, MN 55447-2108
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12-03427 | Other | MN | MEDICA |
| 9L584CA | Other | MN | BCBS |
| 251343900 | Medicaid | MN | |
| 923911015067 | Other | MN | PREFERRED ONE |
| HP19846 | Other | MN | HEALTH PARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 094598-7 | MN | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114988318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17810 24TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554472108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 S 4TH ST",
"address_2": "DHFS, ROOM 510",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554151335",
"telephone_number": "612-673-3548",
"fax_number": "612-673-3866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "LORI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MN",
"license": "094598-7",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "12-03427",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "9L584CA",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "251343900",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "923911015067",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP19846",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.