Provider Demographics
NPI:1992791651
Name:PARENTE, CARRIE DIANE (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:DIANE
Last Name:PARENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:DIANE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 CENTRAL AVE N STE 114
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1232
Mailing Address - Country:US
Mailing Address - Phone:952-476-0783
Mailing Address - Fax:952-487-0573
Practice Address - Street 1:250 CENTRAL AVE N STE 114
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1232
Practice Address - Country:US
Practice Address - Phone:952-476-0783
Practice Address - Fax:952-487-0573
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN468202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry