Healthcare Provider Details

I. General information

NPI: 1639082654
Provider Name (Legal Business Name): ANNE WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 TANGLEFOOT LN
BETTENDORF IA
52722-1608
US

IV. Provider business mailing address

770 TANGLEFOOT LN
BETTENDORF IA
52722-1608
US

V. Phone/Fax

Practice location:
  • Phone: 563-500-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA194276
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: