=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881160794
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAYLEN CABLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2018
-----------------------------------------------------
Last Update Date | 04/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 N LINCOLN ST
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47240-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-805-1130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2408 NW ASHTON LN UNIT 6
-----------------------------------------------------
City | ANKENY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50023-7816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-805-1130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A11725
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------