Healthcare Provider Details

I. General information

NPI: 1023233806
Provider Name (Legal Business Name): DEBORAH LORRAINE VANDERGAAST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PARKVIEW CT
TIPTON IA
52772-1349
US

IV. Provider business mailing address

118 PARKVIEW CT
TIPTON IA
52772-1349
US

V. Phone/Fax

Practice location:
  • Phone: 563-886-3143
  • Fax: 563-886-3143
Mailing address:
  • Phone: 563-886-3143
  • Fax: 563-886-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number104423
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number104423
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number104423
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: