Provider Demographics
NPI:1003291501
Name:GULLICKSON, RENEE (ARNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:GULLICKSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E COLLEGE ST
Mailing Address - Street 2:#211
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-1699
Mailing Address - Country:US
Mailing Address - Phone:319-337-3313
Mailing Address - Fax:
Practice Address - Street 1:221 E COLLEGE ST
Practice Address - Street 2:#211
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-1699
Practice Address - Country:US
Practice Address - Phone:319-337-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDA126328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily