Provider Demographics
NPI:1588794234
Name:DOSTAL, KARA D (CRNA)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:D
Last Name:DOSTAL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:SUITE 21
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51502-1988
Mailing Address - Country:US
Mailing Address - Phone:712-322-5565
Mailing Address - Fax:712-322-5566
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:SUITE 21
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-322-5565
Practice Address - Fax:712-322-5566
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56442367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19969Medicare PIN