Healthcare Provider Details

I. General information

NPI: 1104340884
Provider Name (Legal Business Name): ELISABETH M. HEYING ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W DALE ST STE 102
WATERLOO IA
50703-1900
US

IV. Provider business mailing address

212 W DALE ST STE 102
WATERLOO IA
50703-1900
US

V. Phone/Fax

Practice location:
  • Phone: 319-226-2345
  • Fax:
Mailing address:
  • Phone: 319-226-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC121544
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: