Healthcare Provider Details

I. General information

NPI: 1306543376
Provider Name (Legal Business Name): BROOKLYN ANN MARIE AMUNDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 IOWA AVE W
MARSHALLTOWN IA
50158-4768
US

IV. Provider business mailing address

605 THUNDERBIRD DR
MARSHALLTOWN IA
50158-5297
US

V. Phone/Fax

Practice location:
  • Phone: 641-754-6710
  • Fax:
Mailing address:
  • Phone: 641-751-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number147629
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: