Healthcare Provider Details

I. General information

NPI: 1497031538
Provider Name (Legal Business Name): ALYSSA L UKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA L. JETER

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 53RD AVE
BETTENDORF IA
52722-6279
US

IV. Provider business mailing address

2535 MAPLECREST RD STE 12
BETTENDORF IA
52722-2799
US

V. Phone/Fax

Practice location:
  • Phone: 563-213-5555
  • Fax: 563-421-3530
Mailing address:
  • Phone: 563-421-3555
  • Fax: 563-421-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA115096
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: