Healthcare Provider Details

I. General information

NPI: 1467747782
Provider Name (Legal Business Name): DACIA N WATTS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DACIA N JOHNSON ARNP

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S CLINTON ST STE 168
IOWA CITY IA
52240-4034
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-384-8877
  • Fax: 319-384-0603
Mailing address:
  • Phone: 319-384-8877
  • Fax: 319-384-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA112574
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number04770
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA112574
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-112574
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112574
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2005031446
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number98660
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: