Healthcare Provider Details

I. General information

NPI: 1598276669
Provider Name (Legal Business Name): ROBERT ROGERS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

IV. Provider business mailing address

506 N CHERRY ST
SHELL ROCK IA
50670-7740
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3697
  • Fax:
Mailing address:
  • Phone: 563-210-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA138315
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA138315
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: