Healthcare Provider Details

I. General information

NPI: 1558901447
Provider Name (Legal Business Name): ANEW HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 ASBURY RD
DUBUQUE IA
52002-0483
US

IV. Provider business mailing address

436 GEORGE ST
BELMONT WI
53510-9686
US

V. Phone/Fax

Practice location:
  • Phone: 563-284-2422
  • Fax:
Mailing address:
  • Phone: 608-732-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREA SIMMONS
Title or Position: NURSE PRACTITIONER
Credential: DNP FNP
Phone: 608-732-2280