Healthcare Provider Details

I. General information

NPI: 1205124237
Provider Name (Legal Business Name): SANDRA LYNN SYMENS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 2ND AVE N
FORT DODGE IA
50501-4119
US

IV. Provider business mailing address

24 N 9TH ST
FORT DODGE IA
50501-3905
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-6110
  • Fax:
Mailing address:
  • Phone: 515-574-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-104311
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: