Theresa Carlson

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

239835-30 Issued in WI

Practice address

2300 Western Ave
Manitowoc, WI 54220-3712

Phone

(920) 320-2011

NPI assigned

Feb 13, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1558068114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6925 IRISH RD",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542419542",
            "telephone_number": "414-324-7502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 WESTERN AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542203712",
            "telephone_number": "920-320-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "THERESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "000000",
            "primary": false
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "WI",
            "license": "239835-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia J Cantagallo, MD
• Julie Capello, OTA
• Mark J Capriolo, MD
• Geralyn Ann Carducci, DO
• Nina Carlson
• Jeremiah Carolfi, PHARMD
• Debra Kay Carstens, P.T.A.
• Sierra Marie Carter
• September Lee Casteel, LCSW; LICSW
• Jennifer Cattanach, BSW, SAC-IT

• Emergency Registered Nurse in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Emergency Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.