Provider Demographics
NPI:1568434645
Name:BESCO, WANDA LEA (ARNP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:LEA
Last Name:BESCO
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 1:228 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2981
Mailing Address - Country:US
Mailing Address - Phone:641-682-9955
Mailing Address - Fax:641-682-9946
Practice Address - Street 1:228 E 2ND ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2981
Practice Address - Country:US
Practice Address - Phone:641-682-9955
Practice Address - Fax:641-682-9946
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF076402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0095232Medicaid
IA235223OtherMIDLANDS CHOICE
IA52701OtherWELLMARK
IAI1522Medicare ID - Type Unspecified
IA0095232Medicaid