Healthcare Provider Details

I. General information

NPI: 1730851817
Provider Name (Legal Business Name): AMANDA HEDGE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S MARKET ST
OTTUMWA IA
52501-2924
US

IV. Provider business mailing address

PO BOX 458
OTTUMWA IA
52501-0458
US

V. Phone/Fax

Practice location:
  • Phone: 641-683-5773
  • Fax: 641-226-5759
Mailing address:
  • Phone: 641-684-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA165197
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: