Healthcare Provider Details

I. General information

NPI: 1568987691
Provider Name (Legal Business Name): TERESA R GILMORE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA R GILMORE

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 N 4TH ST
CLINTON IA
52732-2940
US

IV. Provider business mailing address

PO BOX 2341
CLINTON IA
52733-2341
US

V. Phone/Fax

Practice location:
  • Phone: 563-244-5555
  • Fax:
Mailing address:
  • Phone: 563-249-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number115133A
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: