Provider Demographics
NPI:1902859804
Name:LANDPHAIR, ALLYSON RAE (ARNP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:RAE
Last Name:LANDPHAIR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:RAE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2660
Mailing Address - Country:US
Mailing Address - Phone:319-233-6211
Mailing Address - Fax:319-233-2164
Practice Address - Street 1:1753 W RIDGEWAY AVE STE 111
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4588
Practice Address - Country:US
Practice Address - Phone:319-233-6211
Practice Address - Fax:319-233-2164
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA095751363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0453670Medicaid
IA42583OtherWELLMARK INS PLAN
IA421417307F4OtherJOHN DEERE HEALTH INS PLA
IA0453670Medicaid
S90045Medicare UPIN