=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487855698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH IOWA FAMILY HEALTH CARE PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 12/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 1ST ST NW STE 140
-----------------------------------------------------
City | MASON CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50401-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-423-4545
-----------------------------------------------------
Fax | 641-423-4550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 1ST ST NW STE 140
-----------------------------------------------------
City | MASON CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50401-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-423-4545
-----------------------------------------------------
Fax | 641-423-4550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | NICOLLE LEA AMOS
-----------------------------------------------------
Credential | ARNP-C
-----------------------------------------------------
Telephone | 641-423-4545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------