Provider Demographics
NPI:1710975974
Name:COUNTY OF WAPELLO
Entity Type:Organization
Organization Name:COUNTY OF WAPELLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNELLE
Authorized Official - Middle Name:DEVEE
Authorized Official - Last Name:DIERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,BSW
Authorized Official - Phone:641-682-5434
Mailing Address - Street 1:108 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2910
Mailing Address - Country:US
Mailing Address - Phone:641-682-5434
Mailing Address - Fax:641-682-2245
Practice Address - Street 1:108 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2910
Practice Address - Country:US
Practice Address - Phone:641-682-5434
Practice Address - Fax:641-682-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA167038163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA167038Medicare ID - Type Unspecified