Provider Demographics
NPI:1184843914
Name:WERGELAND, NATALIE RUTH
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RUTH
Last Name:WERGELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 UTAH AVE
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:IA
Mailing Address - Zip Code:50545-8712
Mailing Address - Country:US
Mailing Address - Phone:515-824-3706
Mailing Address - Fax:
Practice Address - Street 1:611 10TH AVE N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1462
Practice Address - Country:US
Practice Address - Phone:515-332-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAW18020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0098673Medicaid
IA0098673Medicaid