Healthcare Provider Details

I. General information

NPI: 1962554261
Provider Name (Legal Business Name): BOYER VALLEY COMMUNITY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 IOWA AVE
DUNLAP IA
51529-1537
US

IV. Provider business mailing address

1102 IOWA AVE
DUNLAP IA
51529-1537
US

V. Phone/Fax

Practice location:
  • Phone: 712-643-2258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number110466
License Number StateIA

VIII. Authorized Official

Name: MRS. AMY MALONE
Title or Position: RN
Credential:
Phone: 712-643-2279