Provider Demographics
NPI:1376635482
Name:SAMBERG, KELLY RENEE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:RENEE
Last Name:SAMBERG
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:1223 S GEAR AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1682
Mailing Address - Country:US
Mailing Address - Phone:319-768-3200
Mailing Address - Fax:319-768-3234
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:STE 304
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1682
Practice Address - Country:US
Practice Address - Phone:319-768-3200
Practice Address - Fax:319-768-3234
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAF063968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner