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General NPI Number Information
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NPI Number | 1023087665
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Entity Type | Individual
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Provider Name | AMANDA L. VERVAECKE A.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 1825 LOGAN AVE WOUND & OSTOMY CLINIC
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City | WATERLOO
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State | IA
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Zip | 50703-1916
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Country | US
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Telephone | 319-235-3121
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Fax | 319-226-2113
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Provider Business Mailing Address
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Address Line | 1825 LOGAN AVE WOUND & OSTOMY CLINIC
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City | WATERLOO
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State | IA
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Zip | 50703-1916
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Country | US
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Telephone | 319-235-3121
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Fax | 319-226-2113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A-094001
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License Number State | IA
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