Healthcare Provider Details

I. General information

NPI: 1023731908
Provider Name (Legal Business Name): CARI WATERKOTTE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 VALLEY VIEW DR
MOLINE IL
61265-6138
US

IV. Provider business mailing address

545 VALLEY VIEW DR
MOLINE IL
61265-6138
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-5560
  • Fax: 309-277-1191
Mailing address:
  • Phone: 309-762-5560
  • Fax: 309-277-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.025948
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: