Provider Demographics
NPI:1265948210
Name:RUSSLER, NICOLE A (ARNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:RUSSLER
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 1:3741 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5215
Mailing Address - Country:US
Mailing Address - Phone:319-233-3611
Mailing Address - Fax:319-233-0669
Practice Address - Street 1:3741 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5215
Practice Address - Country:US
Practice Address - Phone:319-233-3611
Practice Address - Fax:319-233-0669
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH119055363LG0600X
IA119055163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse