Provider Demographics
NPI:1013272517
Name:MENUEY, NICOLE ROSE (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSE
Last Name:MENUEY
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 1:601 HIGHWAY 218 N
Mailing Address - Street 2:
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651-1012
Mailing Address - Country:US
Mailing Address - Phone:319-476-4000
Mailing Address - Fax:319-476-4127
Practice Address - Street 1:601 HIGHWAY 218 N
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651-1012
Practice Address - Country:US
Practice Address - Phone:319-476-4000
Practice Address - Fax:319-476-4127
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA111972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily