Provider Demographics
NPI:1134410798
Name:NYBERG, KATIE JOLENE
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JOLENE
Last Name:NYBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 SE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-7113
Mailing Address - Country:US
Mailing Address - Phone:515-473-2737
Mailing Address - Fax:515-978-6662
Practice Address - Street 1:3120 SE 20TH ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-7113
Practice Address - Country:US
Practice Address - Phone:515-473-2737
Practice Address - Fax:515-978-6662
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula