Provider Demographics
NPI:1659589828
Name:ALDRICH, CARLA LOUISE (CRNA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LOUISE
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:LOUISE
Other - Last Name:LEMKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2340 NW 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-9115
Mailing Address - Country:US
Mailing Address - Phone:319-621-7852
Mailing Address - Fax:
Practice Address - Street 1:1316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2019
Practice Address - Country:US
Practice Address - Phone:515-532-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD109990367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03122OtherWELLMARK BCBS
IAP00398444Medicare PIN
IA03122OtherWELLMARK BCBS