Provider Demographics
NPI:1659082618
Name:LERDAL, MONA CHAR (MSN, ARNP, AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:CHAR
Last Name:LERDAL
Suffix:
Gender:F
Credentials:MSN, ARNP, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-7010
Mailing Address - Country:US
Mailing Address - Phone:515-729-3400
Mailing Address - Fax:
Practice Address - Street 1:611 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-7010
Practice Address - Country:US
Practice Address - Phone:515-729-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAW171960364S00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist