Provider Demographics
NPI:1710094354
Name:CALDWELL, CAROL LINDA (RN, ARNP, BC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LINDA
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RN, ARNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:50 NEWTON ROAD
Practice Address - Street 2:101 NURSING BUILDING
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1121
Practice Address - Country:US
Practice Address - Phone:319-335-9654
Practice Address - Fax:319-335-7106
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078364163WP0809X
IAT078369363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1710094354Medicaid
IA1710094354Medicaid
IAI0923094Medicare PIN