Provider Demographics
NPI:1578905832
Name:HEETLAND, KATHRYN ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:HEETLAND
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 1:200 E RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5060
Mailing Address - Country:US
Mailing Address - Phone:319-272-2800
Mailing Address - Fax:319-272-2807
Practice Address - Street 1:200 E RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5060
Practice Address - Country:US
Practice Address - Phone:319-272-2800
Practice Address - Fax:319-272-2807
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH120703363LA2200X
IAJ120703363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology