MEDICARE: WATERLOO VISITING NURSING ASSOCIATION

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	251E00000X	Home Health Agency		IA

Other Identifiers

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

General Provider Information

NPI Number	:	1912901703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERLOO VISITING NURSING ASSOCIATION

Provider Business Mailing Address
First Line	:	2530 UNIVERSITY AVE
Second Line	:	STE 3
City	:	WATERLOO
State	:	IA
Zip	:	50701-3304
Country	:	US
Telephone Number	:	319-235-6201
Fax Number	:	319-232-7296

Provider Business Practice Location Address
First Line	:	2530 UNIVERSITY AVE
Second Line	:	STE 3
City	:	WATERLOO
State	:	IA
Zip	:	50701-3304
Country	:	US
Telephone Number	:	319-235-6201
Fax Number	:	319-232-7296

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. MARY KATHRYN NICHOLAS
Credential	:
Telephone Number	:	319-235-6201

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/21/2022

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