Healthcare Provider Details

I. General information

NPI: 1548246838
Provider Name (Legal Business Name): CAROLE DIANE LIST ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLE DIANE LIST ARNP

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 SERGEANT RD SUITE 230
SIOUX CITY IA
51106-4634
US

IV. Provider business mailing address

4280 SERGEANT RD SUITE 230
SIOUX CITY IA
51106-4634
US

V. Phone/Fax

Practice location:
  • Phone: 712-274-6884
  • Fax: 712-274-6885
Mailing address:
  • Phone: 712-274-6884
  • Fax: 712-274-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-050932
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: