Healthcare Provider Details

I. General information

NPI: 1508060484
Provider Name (Legal Business Name): JOELLEN ANDERSON RN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COLLEGE DR
DECORAH IA
52101-1041
US

IV. Provider business mailing address

2661 W RIDGE RD
WAUKON IA
52172-8501
US

V. Phone/Fax

Practice location:
  • Phone: 563-387-1045
  • Fax:
Mailing address:
  • Phone: 563-568-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number071035
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberJ071035
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberJ-071035
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: