Provider Demographics
NPI:1447859517
Name:AHLGREN, KARISSA L (CNP)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:L
Last Name:AHLGREN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:LEIGH
Other - Last Name:LOZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:19893 CSAH 14
Mailing Address - Street 2:
Mailing Address - City:DARWIN
Mailing Address - State:MN
Mailing Address - Zip Code:55324-6561
Mailing Address - Country:US
Mailing Address - Phone:952-913-0777
Mailing Address - Fax:
Practice Address - Street 1:612 S SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-3340
Practice Address - Country:US
Practice Address - Phone:320-693-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily