Provider Demographics
NPI:1962210591
Name:PFEIFER, CARRIE LYNN (FNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-4100
Mailing Address - Country:US
Mailing Address - Phone:218-220-1362
Mailing Address - Fax:
Practice Address - Street 1:4133 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-4100
Practice Address - Country:US
Practice Address - Phone:218-220-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily