Healthcare Provider Details

I. General information

NPI: 1821067745
Provider Name (Legal Business Name): ROBERTA C WALBURN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN ST.
LINEVILLE IA
50147-9998
US

IV. Provider business mailing address

PO BOX 6
LINEVILLE IA
50147-0006
US

V. Phone/Fax

Practice location:
  • Phone: 641-876-2070
  • Fax: 641-876-2458
Mailing address:
  • Phone: 641-876-2070
  • Fax: 641-876-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-048790
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: