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General NPI Number Information
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NPI Number | 1861006645
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Entity Type | Organization
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Legal Business Name | HISTORIC BLUFFS FAMILY PRACTICE CLINIC., PC
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 666 LORAS BLVD
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City | DUBUQUE
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State | IA
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Zip | 52001-6233
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Country | US
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Telephone | 563-213-1576
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Fax |
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Provider Business Mailing Address
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Address Line | 666 LORAS BLVD
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City | DUBUQUE
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State | IA
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Zip | 52001-6233
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Country | US
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Telephone | 563-213-1576
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | BRENDA HUSEMANN
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Credential | ARNP
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Telephone | 563-213-1576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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