Healthcare Provider Details

I. General information

NPI: 1871079913
Provider Name (Legal Business Name): NUCARA INFUSION CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E SAN MARNAN DR STE 200
WATERLOO IA
50702-5839
US

IV. Provider business mailing address

PO BOX 640
CONRAD IA
50621-0640
US

V. Phone/Fax

Practice location:
  • Phone: 319-236-8891
  • Fax: 319-236-9665
Mailing address:
  • Phone: 641-366-3440
  • Fax: 641-366-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number882
License Number StateIA

VIII. Authorized Official

Name: LORI WILLIS
Title or Position: ACQUISITIONS MANAGER
Credential:
Phone: 641-366-3440