Provider Demographics
NPI:1710475413
Name:ARENSDORF, CAROL L (CNA/CMA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:ARENSDORF
Suffix:
Gender:F
Credentials:CNA/CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-1212
Mailing Address - Country:US
Mailing Address - Phone:563-639-2338
Mailing Address - Fax:562-386-0955
Practice Address - Street 1:1827 W 69TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-1212
Practice Address - Country:US
Practice Address - Phone:563-639-2338
Practice Address - Fax:562-386-0955
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care