Healthcare Provider Details

I. General information

NPI: 1922390137
Provider Name (Legal Business Name): NEW LONDON FAMILY HEALTH LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W WASHINGTON ST
NEW LONDON IA
52645-1329
US

IV. Provider business mailing address

PO BOX 118
NEW LONDON IA
52645-0118
US

V. Phone/Fax

Practice location:
  • Phone: 319-367-2241
  • Fax: 319-367-0549
Mailing address:
  • Phone: 319-367-2241
  • Fax: 319-367-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA099739
License Number StateIA

VIII. Authorized Official

Name: SYLVIA GRABER
Title or Position: OWNER
Credential: ARNP
Phone: 319-931-0098