Healthcare Provider Details

I. General information

NPI: 1558652891
Provider Name (Legal Business Name): CARIE MAE MASTERS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 OSCEOLA AVE SUITE 107
CHARITON IA
50049-1516
US

IV. Provider business mailing address

19782 530TH ST
CHARITON IA
50049-8547
US

V. Phone/Fax

Practice location:
  • Phone: 319-361-6529
  • Fax: 319-228-8776
Mailing address:
  • Phone: 319-361-6529
  • Fax: 319-228-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: