Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | A110578 | IA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | A110578 | IA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2011008067 | IA |
N | 363LW0102X | Nurse Practitioner - Women's Health | A110578 | IA |
NPI | 1023399011 |
---|---|
Provider Name | Tassie Ann Carter |
First Address | Des Moines, IA 50314-2505 |
Second Address | Dubuque, IA 52001-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2011 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GROUP0057570 | (05) | IA |