Provider Demographics
NPI:1073823639
Name:MCFADDEN, ALISON S (ARNP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:S
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4150 KIMBALL AVE
Mailing Address - Street 2:PO BOX 2758
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9086
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-235-5607
Practice Address - Street 1:3254 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5739
Practice Address - Country:US
Practice Address - Phone:319-235-7246
Practice Address - Fax:319-235-3017
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116511363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1073823639Medicaid
IA1073823639Medicaid