Healthcare Provider Details

I. General information

NPI: 1821481045
Provider Name (Legal Business Name): SHAWN THOMAS PLUNKETT ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W DALE ST STE 101
WATERLOO IA
50703-1901
US

IV. Provider business mailing address

146 W DALE ST STE 101
WATERLOO IA
50703-1901
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-3351
  • Fax: 319-235-3132
Mailing address:
  • Phone: 319-233-3351
  • Fax: 319-235-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number135908
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG135908
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: