Healthcare Provider Details

I. General information

NPI: 1538313614
Provider Name (Legal Business Name): SUSAN E RUMELHART ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2008
Last Update Date: 11/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 20TH ST SW
CEDAR RAPIDS IA
52404-1635
US

IV. Provider business mailing address

1243 20TH ST SW
CEDAR RAPIDS IA
52404-1635
US

V. Phone/Fax

Practice location:
  • Phone: 319-558-3473
  • Fax:
Mailing address:
  • Phone: 319-558-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC-061714
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0239434
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: