Provider Demographics
NPI:1760763825
Name:PUETZ, CARRIE NADINE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:NADINE
Last Name:PUETZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1767
Mailing Address - Country:US
Mailing Address - Phone:712-253-6088
Mailing Address - Fax:
Practice Address - Street 1:380 W ANCHOR DR
Practice Address - Street 2:
Practice Address - City:NORTH SIOUX CITY
Practice Address - State:SD
Practice Address - Zip Code:57049-5273
Practice Address - Country:US
Practice Address - Phone:605-360-5043
Practice Address - Fax:612-725-1246
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA--112847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily