Provider Demographics
NPI: | 1356564371 |
---|---|
Name: | ABEL-ZIEG, CARLA K (ARNP) |
Entity type: | Individual |
Prefix: | |
First Name: | CARLA |
Middle Name: | K |
Last Name: | ABEL-ZIEG |
Suffix: | |
Gender: | F |
Credentials: | ARNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 349 |
Mailing Address - Street 2: | |
Mailing Address - City: | DECORAH |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52101 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 563-382-3649 |
Mailing Address - Fax: | 563-382-8183 |
Practice Address - Street 1: | 905 MONTGOMERY STREET |
Practice Address - Street 2: | |
Practice Address - City: | DECORAH |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52101 |
Practice Address - Country: | US |
Practice Address - Phone: | 563-382-3649 |
Practice Address - Fax: | 563-382-8183 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-04-10 |
Last Update Date: | 2017-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | I15078 | 101Y00000X |
IA | 039867 | 363LP0808X |
IA | Z039867 | 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | I15078 | Medicare ID - Type Unspecified |