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NPI Code Detail

MEDICARE: MRS. MICHELLE LYNN VANDEBERG ARNP

MEDICARE:  MRS. MICHELLE LYNN VANDEBERG  ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerA107620IA

General Provider Information

NPI Number : 1013191451
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LYNN VANDEBERG ARNP
Provider Business Mailing Address
First Line : 4205 GLASS RD NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-2514
Country : US
Telephone Number : 319-294-0094
Fax Number : 319-294-0095
Provider Business Practice Location Address
First Line : 105 9TH AVE
Second Line :
City : BELLE PLAINE
State : IA
Zip : 52208-2200
Country : US
Telephone Number : 319-444-2840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2007
Last Update Date : 09/28/2023

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