Healthcare Provider Details

I. General information

NPI: 1457781148
Provider Name (Legal Business Name): BIANCA CARLSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 9TH ST
CORALVILLE IA
52241-2209
US

IV. Provider business mailing address

200 HAWKINS DR DEPARTMENT OF INTERNAL MEDICINE: ENDOCRINOLOGY
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-2000
  • Fax: 319-467-2506
Mailing address:
  • Phone: 855-467-3700
  • Fax: 319-467-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number082332
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5589
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: