Healthcare Provider Details

I. General information

NPI: 1649323429
Provider Name (Legal Business Name): ROCKWELL CITY LYTTON SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TONAWANDA AVE ROCKWELL CITY LYTTON HIGH SCHOOL
ROCKWELL CITY IA
50579
US

IV. Provider business mailing address

1000 TONAWANDA AVE
ROCKWELL CITY IA
50579
US

V. Phone/Fax

Practice location:
  • Phone: 712-297-7341
  • Fax: 712-297-7320
Mailing address:
  • Phone: 712-297-7341
  • Fax: 712-297-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number097435
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT LEE ERICSSON
Title or Position: SCHOOL NURSE REGISTERED NURSE
Credential: REGISTERED NURSE
Phone: 712-297-7341