MEDICARE: TAMARA ALBRIGHT MORTENSON ARNP, FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	A168885	IA

General Provider Information

NPI Number	:	1912645631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA ALBRIGHT MORTENSON ARNP, FNP-BC

Provider Business Mailing Address
First Line	:	1776 WEST LAKES PKWY
Second Line	:	SUITE 100
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8378
Country	:	US
Telephone Number	:	515-241-3510
Fax Number	:	847-235-6130

Provider Business Practice Location Address
First Line	:	1776 WEST LAKES PKWY
Second Line	:	SUITE 100
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8378
Country	:	US
Telephone Number	:	515-241-3510
Fax Number	:	847-235-6130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/18/2023

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