Healthcare Provider Details

I. General information

NPI: 1548947294
Provider Name (Legal Business Name): MRS. MCKAYLA MARIE VANDERPOOL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NW CEDARWOOD DR
ANKENY IA
50023-1065
US

IV. Provider business mailing address

1001 NW CEDARWOOD DR
ANKENY IA
50023-1065
US

V. Phone/Fax

Practice location:
  • Phone: 515-954-8640
  • Fax:
Mailing address:
  • Phone: 515-954-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: