Healthcare Provider Details

I. General information

NPI: 1942980354
Provider Name (Legal Business Name): NYANHIAL C GATLUAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 HIATT ST
CARTER LAKE IA
51510-1210
US

IV. Provider business mailing address

1114 HIATT ST
CARTER LAKE IA
51510-1210
US

V. Phone/Fax

Practice location:
  • Phone: 402-596-5697
  • Fax:
Mailing address:
  • Phone: 402-596-5697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: