Healthcare Provider Details

I. General information

NPI: 1750348041
Provider Name (Legal Business Name): KARRIE VANDER SLUIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 HICKMAN ROAD
CLIVE IA
50325
US

IV. Provider business mailing address

5100 EP TRUE PKWY APT 102
WEST DES MOINES IA
50265-7870
US

V. Phone/Fax

Practice location:
  • Phone: 515-278-1218
  • Fax: 877-711-3281
Mailing address:
  • Phone: 515-402-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number112384
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007463
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: