Healthcare Provider Details

I. General information

NPI: 1093055782
Provider Name (Legal Business Name): MARIELLEN E KRISCHEL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MIDDLEBURY RD
IOWA CITY IA
52245-2712
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-6789
  • Fax: 319-467-7400
Mailing address:
  • Phone: 319-467-6789
  • Fax: 319-467-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA170330
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-010374
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: