Healthcare Provider Details

I. General information

NPI: 1659312254
Provider Name (Legal Business Name): MARY ANN AMEND ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W DALE ST STE 201
WATERLOO IA
50703-1901
US

IV. Provider business mailing address

146 W DALE ST STE 201
WATERLOO IA
50703-1901
US

V. Phone/Fax

Practice location:
  • Phone: 319-226-9888
  • Fax: 319-226-9889
Mailing address:
  • Phone: 319-226-9888
  • Fax: 319-226-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number074072
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: