Renee Beth Carlson

Primary specialty

Mastectomy FitterTaxonomy code 224900000X

Practice address

111 E Water St
Decorah, IA 52101-1801

Phone

(563) 382-6212

Fax

(563) 382-6420

NPI assigned

Jul 10, 2019

Last updated

Jul 10, 2019By the provider in NPPES

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Revelation Inc.

  dba Revelation/Merle Norman Cosmetics/Les Wigs Renee

  • Mastectomy Fitter
  • Decorah, IA
  • NPI 1730731589
  NPD Authorized official

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

{
    "created_epoch": "1562716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562716800000",
    "number": "1659923654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E WATER ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521011801",
            "telephone_number": "563-382-6212",
            "fax_number": "563-382-6420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WATER ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521011801",
            "telephone_number": "563-382-6212",
            "fax_number": "563-382-6420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "RENEE",
        "middle_name": "BETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-10",
        "last_updated": "2019-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224900000X",
            "taxonomy_group": "",
            "desc": "Mastectomy Fitter",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "224900000X",
            "taxonomy_group": "",
            "desc": "Mastectomy Fitter",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "rmnrevelation@live.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "111 E Water St",
            "city": "Decorah",
            "state": "IA",
            "country_code": "US",
            "postal_code": "521011801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmnrevelation@live.com",
            "affiliation": "N",
            "address_1": "111 E Water St",
            "city": "Decorah",
            "state": "IA",
            "country_code": "US",
            "postal_code": "521011801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mark John Buitenwerf, D.D.S.
• James Allen Bullard, M.D.
• Alyssa Bullerman, PTA
• Brenda Lee Burke, MSW., CPM
• Jesse Van Butler, PA-C
• Criag K Carson, OD
• Raelen Carstens, MA, TLMHC
• Champion Chiropractic Life Center Inc (Champion Chiropractic)
• Choice Employment Services
• Carrie Christensen, IADC

• Mastectomy Fitter in Decorah, IA
• Providers in Decorah, IA by specialty
• Mastectomy Fitter in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; 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.