Provider Demographics
NPI:1508695032
Name:THE VILLAGE CLINIC, LLC
Entity type:Organization
Organization Name:THE VILLAGE CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DISCH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:563-499-0437
Mailing Address - Street 1:2107 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-3706
Mailing Address - Country:US
Mailing Address - Phone:563-286-0743
Mailing Address - Fax:563-204-1179
Practice Address - Street 1:2107 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-3706
Practice Address - Country:US
Practice Address - Phone:563-362-3312
Practice Address - Fax:563-204-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty