Healthcare Provider Details

I. General information

NPI: 1790199701
Provider Name (Legal Business Name): CALENE LYNETTE WOODHOUSE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W 53RD ST
DAVENPORT IA
52806-2459
US

IV. Provider business mailing address

1520 W 53RD ST
DAVENPORT IA
52806-2459
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-3800
  • Fax: 563-421-3819
Mailing address:
  • Phone: 563-421-3800
  • Fax: 563-421-3819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA073952
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: