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General NPI Number Information
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NPI Number | 1861551665
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Entity Type | Organization
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Legal Business Name | GARY VOLENTINE MD
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 801 HARMONY ST SUITE 404
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-3106
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Country | US
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Telephone | 712-322-2332
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Fax | 712-322-5122
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Provider Business Mailing Address
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Address Line | 801 HARMONY ST SUITE 404
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-3106
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Country | US
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Telephone | 712-322-2332
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Fax | 712-322-5122
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Authorized Official
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Title or Position | ARNP
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Name | MISS TAMMY K COLEGROVE
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Credential | ARNP
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Telephone | 712-322-2332
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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 | 107489
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 21611
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License Number State | IA
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