Healthcare Provider Details

I. General information

NPI: 1154372548
Provider Name (Legal Business Name): SUSAN RENEE WHITTY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. SUSAN RENEE KLING

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY DR SUITE 200
DUBUQUE IA
52001-7303
US

IV. Provider business mailing address

200 MERCY DR SUITE 200
DUBUQUE IA
52001-7303
US

V. Phone/Fax

Practice location:
  • Phone: 563-582-0145
  • Fax: 562-582-0722
Mailing address:
  • Phone: 563-582-0145
  • Fax: 563-582-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG06483
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: