Healthcare Provider Details

I. General information

NPI: 1083021372
Provider Name (Legal Business Name): NICOLE ANN FERRILL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W AGENCY RD
WEST BURLINGTON IA
52655-1645
US

IV. Provider business mailing address

1201 W AGENCY RD
WEST BURLINGTON IA
52655-1645
US

V. Phone/Fax

Practice location:
  • Phone: 319-754-4242
  • Fax:
Mailing address:
  • Phone: 319-754-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA122752
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: