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General NPI Number Information
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NPI Number | 1366016255
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Entity Type | Individual
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Provider Name | CARLY SCRAMSTAD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 1015 DUFF AVE
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City | AMES
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State | IA
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Zip | 50010-5733
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Country | US
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Telephone | 515-239-4435
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Fax |
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Provider Business Mailing Address
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Address Line | 301 MAIN ST UNIT 407
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City | AMES
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State | IA
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Zip | 50010-6155
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Country | US
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Telephone | 204-330-3787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD-47928
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License Number State | IA
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