Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A127170 | IA |
NPI | 1003214263 |
---|---|
Provider Name | Carl Markley |
First Address | Ames, IA 50010-6226 |
Second Address | Ames, IA 50010-6226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2014 |
Last Update Date | 19/12/2014 |