Healthcare Provider Details

I. General information

NPI: 1033771258
Provider Name (Legal Business Name): TYEISHA MARIE WASHINGTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TYEISHA WASHINGTON NP

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-1616
  • Fax:
Mailing address:
  • Phone: 319-356-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH156070
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH156070
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberH156070
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberH156070
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: