Healthcare Provider Details

I. General information

NPI: 1669552964
Provider Name (Legal Business Name): JANICE MARIE NEAL RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 W 9TH ST
WATERLOO IA
50702-5310
US

IV. Provider business mailing address

1152 LEONA AVE
WATERLOO IA
50702-5322
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-2893
  • Fax: 319-234-0354
Mailing address:
  • Phone: 319-233-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number003257
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: