Provider Demographics
NPI:1215992771
Name:OELTJENBRUNS, CAROLYN SUE (CNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:SUE
Last Name:OELTJENBRUNS
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Gender:F
Credentials:CNP
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Mailing Address - Street 1:16372 KENRICK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044
Mailing Address - Country:US
Mailing Address - Phone:952-892-6700
Mailing Address - Fax:952-892-9475
Practice Address - Street 1:16372 KENRICK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044
Practice Address - Country:US
Practice Address - Phone:952-892-6700
Practice Address - Fax:952-892-9475
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR1124260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNQ05484Medicare UPIN