Healthcare Provider Details

I. General information

NPI: 1053076976
Provider Name (Legal Business Name): MRS. KATHARINE CELIA RUESTOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 9TH ST
CORALVILLE IA
52241-2209
US

IV. Provider business mailing address

105 E 9TH ST
CORALVILLE IA
52241-2209
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-2000
  • Fax: 319-467-2506
Mailing address:
  • Phone: 319-467-2000
  • Fax: 319-467-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH168542
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: