Healthcare Provider Details

I. General information

NPI: 1659364776
Provider Name (Legal Business Name): AMANDA C KLEESE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA C SMITH

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S IOWA AVE
WASHINGTON IA
52353-1144
US

IV. Provider business mailing address

PO BOX 909
WASHINGTON IA
52353-0909
US

V. Phone/Fax

Practice location:
  • Phone: 319-653-7291
  • Fax: 319-653-7440
Mailing address:
  • Phone: 319-653-7291
  • Fax: 319-653-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC103068
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: