Basic Information
Provider Information | |||||||||
NPI: | 1669632436 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOLTERS | ||||||||
FirstName: | KAREN | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HARWICK | ||||||||
OtherFirstName: | KAREN | ||||||||
OtherMiddleName: | MARGARET | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3014 | ||||||||
Address2: | 1215 DUFF AVE MCFARLAND CLINIC, PC | ||||||||
City: | AMES | ||||||||
State: | IA | ||||||||
PostalCode: | 500103014 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152394400 | ||||||||
FaxNumber: | 5152394446 | ||||||||
Practice Location | |||||||||
Address1: | 1111 DUFF AVE | ||||||||
Address2: | MCFARLAND CLINIC, PC | ||||||||
City: | AMES | ||||||||
State: | IA | ||||||||
PostalCode: | 500103014 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152392155 | ||||||||
FaxNumber: | 5152392050 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2008 | ||||||||
LastUpdateDate: | 11/20/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/20/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 6895723-1206 | UT | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363A00000X | 002188 | IA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
No ID Information.