Healthcare Provider Details

I. General information

NPI: 1346724713
Provider Name (Legal Business Name): JODY L VAN VEEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY L TIMMINS

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MONROE ST
PELLA IA
50219-1290
US

IV. Provider business mailing address

746 RODEO AVE
MONROE IA
50170-8787
US

V. Phone/Fax

Practice location:
  • Phone: 641-628-6629
  • Fax:
Mailing address:
  • Phone: 641-521-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA093648
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA093648
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA093648
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: