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NPI Code Detail

MEDICARE: MARIELLA ANN VANDERGAAST RN

MEDICARE: MARIELLA ANN VANDERGAAST RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0809XAdult Psychiatric/Mental Health Registered Nurse133097IA

General Provider Information

NPI Number : 1427910918
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIELLA ANN VANDERGAAST RN
Provider Business Mailing Address
First Line : 2213 2ND ST
Second Line :
City : CORALVILLE
State : IA
Zip : 52241-1205
Country : US
Telephone Number : 319-688-3383
Fax Number : 319-688-3425
Provider Business Practice Location Address
First Line : 2213 2ND ST
Second Line :
City : CORALVILLE
State : IA
Zip : 52241-1205
Country : US
Telephone Number : 319-688-3383
Fax Number : 319-688-3425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2025
Last Update Date : 12/02/2025

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