Healthcare Provider Details

I. General information

NPI: 1821690223
Provider Name (Legal Business Name): CARA JEAN ELLIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 KENYON RD
FORT DODGE IA
50501-5740
US

IV. Provider business mailing address

1115 1ST ST
BOONE IA
50036-3626
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-6800
  • Fax:
Mailing address:
  • Phone: 515-298-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA161435
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: