Healthcare Provider Details

I. General information

NPI: 1356330161
Provider Name (Legal Business Name): BETH A SADEWASSER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 1ST ST SE
WAUKON IA
52172-2022
US

IV. Provider business mailing address

PO BOX 370
GUTTENBERG IA
52052-0370
US

V. Phone/Fax

Practice location:
  • Phone: 563-568-3411
  • Fax: 563-568-6139
Mailing address:
  • Phone: 563-252-2141
  • Fax: 563-252-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA087627
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number087627
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: