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General NPI Number Information
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NPI Number | 1013328673
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Entity Type | Organization
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Legal Business Name | ACI MEDICINE
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 880 TANGLEFOOT LN
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City | BETTENDORF
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State | IA
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Zip | 52722-1605
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Country | US
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Telephone | 309-678-4372
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Fax |
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Provider Business Mailing Address
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Address Line | 880 TANGLEFOOT LN
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City | BETTENDORF
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State | IA
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Zip | 52722-1605
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Country | US
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Telephone | 309-678-4372
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SHAWN SNIDER
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Credential | NP
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Telephone | 130-967-4372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A128168
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License Number State | IA
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