Provider Demographics
NPI:1962879916
Name:LUCIO, CARRIE ROSE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ROSE
Last Name:LUCIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:ROSE
Other - Last Name:KULLMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:807 ALBERT ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1302
Mailing Address - Country:US
Mailing Address - Phone:651-373-4587
Mailing Address - Fax:
Practice Address - Street 1:807 ALBERT ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1302
Practice Address - Country:US
Practice Address - Phone:651-373-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 3922363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health