Healthcare Provider Details

I. General information

NPI: 1932581881
Provider Name (Legal Business Name): MARY ELLEN DEUTMEYER A.R.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 TOWER PARK DR
WATERLOO IA
50701-9098
US

IV. Provider business mailing address

945 TOWER PARK DR
WATERLOO IA
50701-9098
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-1230
  • Fax: 319-235-1229
Mailing address:
  • Phone: 319-235-1230
  • Fax: 319-235-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberA096094
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: