Healthcare Provider Details

I. General information

NPI: 1366442337
Provider Name (Legal Business Name): SUSAN JANE HANDKE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SERGEANT SQUARE DR
SERGEANT BLUFF IA
51054-7729
US

IV. Provider business mailing address

319 SERGEANT SQUARE DR
SERGEANT BLUFF IA
51054-7729
US

V. Phone/Fax

Practice location:
  • Phone: 712-943-2500
  • Fax: 712-943-5696
Mailing address:
  • Phone: 712-943-2500
  • Fax: 712-943-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA068082
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: