Healthcare Provider Details

I. General information

NPI: 1053384396
Provider Name (Legal Business Name): CAROLYN KAY WHITE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 WESTOWN PKWY
WEST DES MOINES IA
50266-8218
US

IV. Provider business mailing address

5901 WESTOWN PKWY
WEST DES MOINES IA
50266-8297
US

V. Phone/Fax

Practice location:
  • Phone: 515-221-9222
  • Fax: 515-221-0575
Mailing address:
  • Phone: 515-221-9222
  • Fax: 515-221-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD-038634
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: