Healthcare Provider Details

I. General information

NPI: 1396000337
Provider Name (Legal Business Name): ORIETTA GIRARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 05/19/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 W 9TH ST
WATERLOO IA
50702-5914
US

IV. Provider business mailing address

3840 W 9TH ST
WATERLOO IA
50702-5914
US

V. Phone/Fax

Practice location:
  • Phone: 319-236-3858
  • Fax: 319-236-3644
Mailing address:
  • Phone: 319-236-3858
  • Fax: 319-236-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD-42076
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-42076
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: