Healthcare Provider Details

I. General information

NPI: 1780663005
Provider Name (Legal Business Name): MARY JO HENRY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 8TH ST NE
CEDAR RAPIDS IA
52401
US

IV. Provider business mailing address

115 8TH ST NE
CEDAR RAPIDS IA
52401
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-3565
  • Fax: 319-363-4001
Mailing address:
  • Phone: 319-363-3565
  • Fax: 319-363-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA081743
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: