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General NPI Number Information
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NPI Number | 1619153608
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Entity Type | Individual
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Provider Name | MADONNA SUSAN CARR P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 1765 LININGER LN
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-2316
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Country | US
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Telephone | 319-665-3073
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Fax |
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Provider Business Mailing Address
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Address Line | 1865 LININGER LANE MERCY CARE URGENT CARE NORTH LIBERTY
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-9575
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Country | US
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Telephone | 319-665-3073
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 005082
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001987
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License Number State | IA
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