Healthcare Provider Details

I. General information

NPI: 1316228588
Provider Name (Legal Business Name): SHELLY L MCGURK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCY CARDIOLOGY CLINIC 788 8TH AVENUE SE, SUITE 400
CEDAR RAPIDS IA
52401
US

IV. Provider business mailing address

MERCY CARDIOLOGY CLINIC 788 8TH AVENUE SE, SUITE 400
CEDAR RAPIDS IA
52401
US

V. Phone/Fax

Practice location:
  • Phone: 319-832-2328
  • Fax: 319-832-1168
Mailing address:
  • Phone: 319-832-2328
  • Fax: 319-832-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberL085666
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: