Healthcare Provider Details

I. General information

NPI: 1396388302
Provider Name (Legal Business Name): ADRIANNA VANDUYNE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 02/23/2022
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 16TH AVE
FULTON IL
61252-9708
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-2511
  • Fax:
Mailing address:
  • Phone: 319-384-0520
  • Fax: 319-384-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.019814
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA155616
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: