Provider Demographics
NPI:1518955822
Name:ELLERTSON, CAROL ANN (ARNP, MS, CNM)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:ELLERTSON
Suffix:
Gender:F
Credentials:ARNP, MS, CNM
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4414
Mailing Address - Fax:515-239-4786
Practice Address - Street 1:1015 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-4414
Practice Address - Fax:515-239-4786
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB059680367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419549Medicaid
IAS76206Medicare UPIN
IA0419549Medicaid