Healthcare Provider Details

I. General information

NPI: 1700436474
Provider Name (Legal Business Name): MRS. WHITNEY AMELIA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S GEAR AVE STE 109
WEST BURLINGTON IA
52655-1685
US

IV. Provider business mailing address

1223 S GEAR AVE STE 109
WEST BURLINGTON IA
52655-1685
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-1820
  • Fax:
Mailing address:
  • Phone: 319-768-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH157436
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number125151
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: