Healthcare Provider Details

I. General information

NPI: 1871844290
Provider Name (Legal Business Name): DORA GRACE HOUTS ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

IV. Provider business mailing address

5540 BROKEN KETTLE RD
SIOUX CITY IA
51108-9504
US

V. Phone/Fax

Practice location:
  • Phone: 712-279-7986
  • Fax: 712-279-3799
Mailing address:
  • Phone: 712-301-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberA083035
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberA083035
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA083035
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: