Healthcare Provider Details

I. General information

NPI: 1477106730
Provider Name (Legal Business Name): TONI DELAGARDELLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 FRANKLIN ST
WATERLOO IA
50703-4407
US

IV. Provider business mailing address

5055 PRAIRIE RIDGE AVE
MARION IA
52302-9027
US

V. Phone/Fax

Practice location:
  • Phone: 319-874-3000
  • Fax: 319-874-3411
Mailing address:
  • Phone: 319-360-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9421
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9421
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC154088
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: