Provider Demographics
NPI:1487931614
Name:CARLSON, BRENDA LEE (APRN, ACNS-BC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:APRN, ACNS-BC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:HOSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, ACNS-BC
Mailing Address - Street 1:9197 NW POLK CITY DR
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9197 NW POLK CITY DR
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-2042
Practice Address - Country:US
Practice Address - Phone:515-360-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS-067510364S00000X
IAQ067510363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist