Basic Information
| Provider Information | |||||||||
| NPI: | 1275808644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAYNE | ||||||||
| FirstName: | ARRIEL | ||||||||
| MiddleName: | MIKAELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 E UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503162302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152635612 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 E UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503162302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152635612 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2012 | ||||||||
| LastUpdateDate: | 12/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | D120212 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.