Healthcare Provider Details

I. General information

NPI: 1104805209
Provider Name (Legal Business Name): JO ANNE MACASAET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S CLARK ST
CARROLL IA
51401-3038
US

IV. Provider business mailing address

311 S CLARK ST
CARROLL IA
51401-3038
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-8435
  • Fax: 712-792-1751
Mailing address:
  • Phone: 712-792-3581
  • Fax: 712-792-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32696
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: