Provider Demographics
NPI:1194123091
Name:CARAVELLO, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CARAVELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14745 CAMERO LN
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4405
Mailing Address - Country:US
Mailing Address - Phone:651-353-6484
Mailing Address - Fax:
Practice Address - Street 1:14745 CAMERO LN
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-4405
Practice Address - Country:US
Practice Address - Phone:651-353-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR145002-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse