Healthcare Provider Details

I. General information

NPI: 1073677019
Provider Name (Legal Business Name): AMANA FAMILY PRACTICE CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 39TH AVE
AMANA IA
52203-8229
US

IV. Provider business mailing address

505 39TH AVE PO BOX 207
AMANA IA
52203-8229
US

V. Phone/Fax

Practice location:
  • Phone: 319-622-3231
  • Fax: 319-622-3077
Mailing address:
  • Phone: 319-622-3231
  • Fax: 319-622-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA L ZIMMERMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 319-622-3231