Provider Demographics
NPI:1134580657
Name:SLATER, NICOLE D (ARNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:SLATER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1753 W RIDGEWAY AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4544
Mailing Address - Country:US
Mailing Address - Phone:319-833-5888
Mailing Address - Fax:319-833-5891
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:STE 102
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4544
Practice Address - Country:US
Practice Address - Phone:319-833-5888
Practice Address - Fax:319-833-5891
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA117141363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner