Healthcare Provider Details

I. General information

NPI: 1770147902
Provider Name (Legal Business Name): TIMOTHY THOMAS SAUNDERS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 DODGE ST STE 135
DUBUQUE IA
52003-5214
US

IV. Provider business mailing address

1515 DELHI ST STE 100
DUBUQUE IA
52001-6320
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-9111
  • Fax:
Mailing address:
  • Phone: 563-557-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA130281
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: