Healthcare Provider Details

I. General information

NPI: 1669097317
Provider Name (Legal Business Name): KRISTA ANN WILLENBRING AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA ANN OSTWINKLE

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SAINT FRANCIS DR STE 411
WATERLOO IA
50702-5634
US

IV. Provider business mailing address

2710 SAINT FRANCIS DR STE 411
WATERLOO IA
50702-5634
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-5000
  • Fax: 319-272-5825
Mailing address:
  • Phone: 319-272-5000
  • Fax: 319-272-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number101275
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: