=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932581881
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ELLEN DEUTMEYER A.R.N.P
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2015
-----------------------------------------------------
Last Update Date | 05/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 945 TOWER PARK DR
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50701-9098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-235-1230
-----------------------------------------------------
Fax | 319-235-1229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 945 TOWER PARK DR
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50701-9098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-235-1230
-----------------------------------------------------
Fax | 319-235-1229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SF0001X
-----------------------------------------------------
Taxonomy Name | Family Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | A096094
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------