MEDICARE: CAROLE DIANE LIST ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A-050932	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548246838	OTHER	IA	NPI

General Provider Information

NPI Number	:	1548246838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE DIANE LIST ARNP

Provider Business Mailing Address
First Line	:	4280 SERGEANT RD
Second Line	:	SUITE 230
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4634
Country	:	US
Telephone Number	:	712-274-6884
Fax Number	:	712-274-6885

Provider Business Practice Location Address
First Line	:	4280 SERGEANT RD
Second Line	:	SUITE 230
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4634
Country	:	US
Telephone Number	:	712-274-6884
Fax Number	:	712-274-6885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	09/30/2013

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Directions to “ CAROLE DIANE LIST ARNP” Practice Location

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