Provider Demographics
NPI:1780917831
Name:BELLOMA, CAROL (ARNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BELLOMA
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 1:1 ST. JOSEPH'S DRIVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544
Mailing Address - Country:US
Mailing Address - Phone:641-437-3399
Mailing Address - Fax:641-437-3403
Practice Address - Street 1:1 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-9017
Practice Address - Country:US
Practice Address - Phone:641-437-3399
Practice Address - Fax:641-437-3403
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner