Provider Demographics
NPI:1962400770
Name:MENKE, CAROL A (PA)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:MENKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1225 S GEAR AVE STE 252
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1687
Practice Address - Country:US
Practice Address - Phone:319-752-1805
Practice Address - Fax:319-752-1629
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA1106363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0136119Medicaid
IAI6570OtherMEDICARE GROUP#
IA16DO913344OtherCLIA #
IA1106OtherIOWA LICENSE #
IA48897OtherBCBS OF IOWA
IAMMO311958OtherDEA #
IAP60199Medicare UPIN
IAI6572Medicare PIN