Healthcare Provider Details

I. General information

NPI: 1982106712
Provider Name (Legal Business Name): RAELEE LYNN BIRD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAELEE LYNN WIGGINS

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 06/09/2021
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E ZELLER ST STE D
NORTH LIBERTY IA
52317-9248
US

IV. Provider business mailing address

PO BOX 125
BRIGHTON IA
52540-0125
US

V. Phone/Fax

Practice location:
  • Phone: 319-853-0068
  • Fax:
Mailing address:
  • Phone: 319-461-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH137415
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number137415
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: