Healthcare Provider Details

I. General information

NPI: 1427998608
Provider Name (Legal Business Name): ANDREA LAVONNE YOUNGBLUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2413 W RIDGEWAY AVE STE 2
WATERLOO IA
50701-4310
US

IV. Provider business mailing address

434 HOPKINS ST
JESUP IA
50648-9739
US

V. Phone/Fax

Practice location:
  • Phone: 319-236-1911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA190436
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: