Healthcare Provider Details

I. General information

NPI: 1528971041
Provider Name (Legal Business Name): AMY BLANCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 5TH AVE NE
INDEPENDENCE IA
50644-1463
US

IV. Provider business mailing address

900 5TH AVE NE
INDEPENDENCE IA
50644-1463
US

V. Phone/Fax

Practice location:
  • Phone: 800-592-8097
  • Fax: 224-325-3218
Mailing address:
  • Phone: 800-592-8097
  • Fax: 224-325-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number098298
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: