Healthcare Provider Details

I. General information

NPI: 1164387726
Provider Name (Legal Business Name): AMBER BAELE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 W LOCUST ST STE 2A
DAVENPORT IA
52804-3354
US

IV. Provider business mailing address

8135 119TH ST
BLUE GRASS IA
52726-9505
US

V. Phone/Fax

Practice location:
  • Phone: 563-322-8528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP62538
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: