Provider Demographics
NPI:1467054569
Name:WALES, CARRIE ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:WALES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:CROSSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 S 70TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4283
Mailing Address - Country:US
Mailing Address - Phone:402-235-4701
Mailing Address - Fax:
Practice Address - Street 1:4500 S 70TH ST
Practice Address - Street 2:SUITE 117
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4283
Practice Address - Country:US
Practice Address - Phone:402-235-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily