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General NPI Number Information
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NPI Number | 1891433496
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Entity Type | Organization
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Legal Business Name | STILL WATERS MENTAL HEALTH AND WELLNESS PLLC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 317 HWY 150 NORTH
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City | WEST UNION
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State | IA
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Zip | 52175
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Country | US
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Telephone | 563-278-2432
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Fax | 563-316-6841
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Provider Business Mailing Address
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Address Line | PO BOX 342
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City | WEST UNION
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State | IA
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Zip | 52175-0342
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Country | US
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Telephone | 563-278-2432
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Fax | 563-316-6841
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Authorized Official
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Title or Position | OWNER
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Name | NICOLETTE MABB
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Credential | DNP, ARNP, PMHNP-BC
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Telephone | 563-774-2083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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