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NPI Code Detail

MEDICARE: AMY MARGARET WINE L.I.S.W.

MEDICARE: AMY MARGARET WINE L.I.S.W.
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
1104100000XSocial Worker05946IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679676480
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MARGARET WINE L.I.S.W.
Provider Business Mailing Address
First Line : 2485 TECH DR
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-3262
Country : US
Telephone Number : 563-355-1611
Fax Number : 563-355-6617
Provider Business Practice Location Address
First Line : 2485 TECH DR
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-3262
Country : US
Telephone Number : 563-355-1611
Fax Number : 563-355-6617
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2006
Last Update Date : 06/22/2009

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