Healthcare Provider Details

I. General information

NPI: 1255823506
Provider Name (Legal Business Name): NICOLE DELAGARDELLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 W 9TH ST
WATERLOO IA
50702
US

IV. Provider business mailing address

4250 LAFAYETTE RD
EVANSDALE IA
50707-1226
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-2893
  • Fax:
Mailing address:
  • Phone: 319-269-3374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG139136
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: