Provider Demographics
NPI:1831484898
Name:PROSE, HEIDI L (ARNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:PROSE
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 1:312 9TH ST SW STE 1200
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2909
Mailing Address - Country:US
Mailing Address - Phone:319-352-4340
Mailing Address - Fax:319-352-0745
Practice Address - Street 1:312 9TH ST SW STE 1200
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2909
Practice Address - Country:US
Practice Address - Phone:319-352-4340
Practice Address - Fax:319-352-0745
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-121410363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner