Healthcare Provider Details

I. General information

NPI: 1083580088
Provider Name (Legal Business Name): NICHOLE SUSANNE MINCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/24/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 53RD AVE
BETTENDORF IA
52722-6279
US

IV. Provider business mailing address

2140 53RD AVE
BETTENDORF IA
52722-6279
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209032750
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA187473
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: