=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881419356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE TERRI DENTLINGER RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2024
-----------------------------------------------------
Last Update Date | 04/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 608 NW 7TH ST
-----------------------------------------------------
City | POCAHONTAS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50574-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-335-5632
-----------------------------------------------------
Fax | 712-335-4148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 608 NW 7TH ST
-----------------------------------------------------
City | POCAHONTAS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50574-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-335-5632
-----------------------------------------------------
Fax | 712-335-4148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | A189941
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------