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General NPI Number Information
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NPI Number | 1851425276
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERANS AFFAIRS OUTPATIENT CLINIC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1015 S HACKETT RD
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City | WATERLOO
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State | IA
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Zip |
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Country | US
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Telephone | 319-235-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 228 OAKWOOD DR
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City | EVANSDALE
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State | IA
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Zip | 50707-1850
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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 | L.P.N.
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Name | JULIE TULLIS
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Credential |
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Telephone | 319-234-3187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 261QV0200X
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License Number State | IA
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