Healthcare Provider Details

I. General information

NPI: 1033576616
Provider Name (Legal Business Name): TESSA J RYDBERG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W MILWAUKEE AVE
STORM LAKE IA
50588-1564
US

IV. Provider business mailing address

715 W MILWAUKEE AVE
STORM LAKE IA
50588-1564
US

V. Phone/Fax

Practice location:
  • Phone: 712-213-0109
  • Fax:
Mailing address:
  • Phone: 712-213-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number113088
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA119098
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: