Healthcare Provider Details

I. General information

NPI: 1164393542
Provider Name (Legal Business Name): NICOLE F QUANDAHL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 8TH AVE W
CRESCO IA
52136-1062
US

IV. Provider business mailing address

235 8TH AVE W
CRESCO IA
52136-1062
US

V. Phone/Fax

Practice location:
  • Phone: 563-547-2101
  • Fax: 563-547-3448
Mailing address:
  • Phone: 563-547-2101
  • Fax: 563-547-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA186863
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: