Healthcare Provider Details

I. General information

NPI: 1013751692
Provider Name (Legal Business Name): ANDREW NADERMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MERCY DR
DUBUQUE IA
52001-7320
US

IV. Provider business mailing address

545 COOPER PL
DUBUQUE IA
52001-6627
US

V. Phone/Fax

Practice location:
  • Phone: 563-589-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number129251
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: