Healthcare Provider Details

I. General information

NPI: 1114212479
Provider Name (Legal Business Name): KERRI MARIE VANEE ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E BREMER AVE STE 100
WAVERLY IA
50677-3317
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-239-9194
  • Fax:
Mailing address:
  • Phone: 319-235-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberL106771
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberL-106771
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: