Provider Demographics
NPI:1306830070
Name:TITUS, GREGORY WAYNE (ARNP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:WAYNE
Last Name:TITUS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2138
Mailing Address - Country:US
Mailing Address - Phone:641-684-3000
Mailing Address - Fax:641-684-2469
Practice Address - Street 1:931 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2138
Practice Address - Country:US
Practice Address - Phone:641-684-3000
Practice Address - Fax:641-684-2469
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090162163W00000X
IAC090162363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA041S954Medicaid
42068106092OtherJOHN DEERE HEALTH
IA026810OtherIOWA HEALTH SOLUTIONS
IAI5929Medicare PIN
P5501Medicare UPIN