Provider Demographics
NPI:1548246838
Name:LIST, CAROLE DIANE (ARNP)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:DIANE
Last Name:LIST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:DIANE
Other - Last Name:LIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:4280 SERGEANT RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4634
Mailing Address - Country:US
Mailing Address - Phone:712-274-6884
Mailing Address - Fax:712-274-6885
Practice Address - Street 1:4280 SERGEANT RD
Practice Address - Street 2:SUITE 230
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4634
Practice Address - Country:US
Practice Address - Phone:712-274-6884
Practice Address - Fax:712-274-6885
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-050932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1548246838OtherNPI