Provider Demographics
NPI:1417220377
Name:VRIEZEMA, CARMEN LYNN (AC/ AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:LYNN
Last Name:VRIEZEMA
Suffix:
Gender:F
Credentials:AC/ AGPCNP-BC
Other - Prefix:MISS
Other - First Name:CARMEN
Other - Middle Name:LYNN
Other - Last Name:CROWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5122 LAKE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8290
Mailing Address - Country:US
Mailing Address - Phone:972-977-8108
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:972-977-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121443363LA2100X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care