Provider Demographics
NPI:1891806790
Name:WAUTERS, HEIDI M (ARNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:WAUTERS
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 1:255 W LUCAS ST
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IA
Mailing Address - Zip Code:52301-1331
Mailing Address - Country:US
Mailing Address - Phone:319-741-6798
Mailing Address - Fax:319-741-6791
Practice Address - Street 1:255 W LUCAS ST
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301-1331
Practice Address - Country:US
Practice Address - Phone:319-741-6798
Practice Address - Fax:319-741-6791
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAQ64454Medicare UPIN