Provider Demographics
NPI:1972578722
Name:TWEDT, SALLY (CPNP,ARNP)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:TWEDT
Suffix:
Gender:F
Credentials:CPNP,ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3903
Mailing Address - Country:US
Mailing Address - Phone:515-255-3181
Mailing Address - Fax:515-255-9392
Practice Address - Street 1:2301 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3903
Practice Address - Country:US
Practice Address - Phone:515-255-3181
Practice Address - Fax:515-255-9392
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC-098350363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0477943Medicaid