Provider Demographics
NPI:1952398018
Name:CARLSON, NANCY LOUISE (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LOUISE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:LOUISE
Other - Last Name:MALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:705 8TH ST
Mailing Address - Street 2:
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-1301
Mailing Address - Country:US
Mailing Address - Phone:515-733-5191
Mailing Address - Fax:515-733-5354
Practice Address - Street 1:705 8TH ST
Practice Address - Street 2:
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1301
Practice Address - Country:US
Practice Address - Phone:515-733-5191
Practice Address - Fax:515-733-5354
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2078535Medicaid
IA2078535Medicaid
IAI21876Medicare PIN