Healthcare Provider Details

I. General information

NPI: 1114551223
Provider Name (Legal Business Name): TRIUNE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 COTTAGE ST
ADEL IA
50003-2111
US

IV. Provider business mailing address

715 COTTAGE ST
ADEL IA
50003-2111
US

V. Phone/Fax

Practice location:
  • Phone: 515-478-9660
  • Fax:
Mailing address:
  • Phone: 515-478-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DELECIA CRANNELL
Title or Position: OWNER/PROVIDER
Credential: ARNP
Phone: 515-478-9660