Healthcare Provider Details

I. General information

NPI: 1710211594
Provider Name (Legal Business Name): ELIZABETH A GUDGEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH A SIBBING FNP

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 114TH ST
CLIVE IA
50325-7007
US

IV. Provider business mailing address

PO BOX 1475
DES MOINES IA
50305-1475
US

V. Phone/Fax

Practice location:
  • Phone: 515-222-7000
  • Fax: 515-222-7037
Mailing address:
  • Phone: 515-222-7000
  • Fax: 515-222-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-115463
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: