Healthcare Provider Details

I. General information

NPI: 1710925797
Provider Name (Legal Business Name): HEART OF THE VALLEY HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 MAIN ST
ELGIN IA
52141-9616
US

IV. Provider business mailing address

1014 MAIN ST
ELGIN IA
52141-9616
US

V. Phone/Fax

Practice location:
  • Phone: 563-426-5136
  • Fax: 563-426-5139
Mailing address:
  • Phone: 563-426-5136
  • Fax: 563-426-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-112377
License Number StateIA

VIII. Authorized Official

Name: MS. SHARON EILEEN J HARRIS
Title or Position: CEO
Credential: APRN
Phone: 563-426-5136