Healthcare Provider Details

I. General information

NPI: 1588401053
Provider Name (Legal Business Name): JADYN FORSYTH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 LOGAN AVE STE A
WATERLOO IA
50703-1002
US

IV. Provider business mailing address

2140 LOGAN AVE STE A
WATERLOO IA
50703-1002
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-4431
  • Fax: 319-226-8445
Mailing address:
  • Phone: 319-234-4431
  • Fax: 319-226-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA178754
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: