Provider Demographics
NPI:1104896273
Name:CRALL, CATHERINE M (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:CRALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WOMENS WELLNESS CENTER, PC
Mailing Address - Street 2:PO BOX 2400
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2400
Mailing Address - Country:US
Mailing Address - Phone:319-233-3044
Mailing Address - Fax:319-233-0722
Practice Address - Street 1:WOMENS WELLNESS CENTER, PC
Practice Address - Street 2:777 MAZZUCHELLI PLACE
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001
Practice Address - Country:US
Practice Address - Phone:563-588-0011
Practice Address - Fax:563-588-0595
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2044685Medicaid
B18080Medicare UPIN
IAI14740Medicare ID - Type Unspecified