Provider Demographics
NPI:1053645291
Name:WYCOFF, CARMEN RENEE (RN, MSN, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:RENEE
Last Name:WYCOFF
Suffix:
Gender:F
Credentials:RN, MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:411 10TH ST SE STE 150
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2449
Mailing Address - Country:US
Mailing Address - Phone:319-363-3600
Mailing Address - Fax:319-393-0184
Practice Address - Street 1:411 10TH ST SE STE 150
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2449
Practice Address - Country:US
Practice Address - Phone:319-363-3600
Practice Address - Fax:319-393-0184
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAC-096428363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics