Healthcare Provider Details

I. General information

NPI: 1881972412
Provider Name (Legal Business Name): RACHEL J WURTH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL J MADSEN

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH ST
SIOUX CITY IA
51101-1317
US

IV. Provider business mailing address

800 5TH ST
SIOUX CITY IA
51101-1317
US

V. Phone/Fax

Practice location:
  • Phone: 712-234-2353
  • Fax: 712-234-2396
Mailing address:
  • Phone: 712-234-2353
  • Fax: 712-234-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA089999
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: