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General NPI Number Information
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NPI Number | 1841973443
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Entity Type | Individual
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Provider Name | JONATHAN WALTER WILLOUGHBY DNP DET BSN RN
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Gender | Male
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 345 N JUNIPER ST
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-7821
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Country | US
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Telephone | 319-206-6165
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Fax |
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Provider Business Mailing Address
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Address Line | 345 N JUNIPER ST
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-7821
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Country | US
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Telephone |
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Fax |
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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 | A185262
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 164027
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License Number State | IA
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