Provider Demographics
NPI:1801932181
Name:DEPARTMENT OF VETERANS AFFAIRS
Entity type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DELAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:563-332-8528
Mailing Address - Street 1:266-31 AVE.
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244
Mailing Address - Country:US
Mailing Address - Phone:309-755-6755
Mailing Address - Fax:
Practice Address - Street 1:2979 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2784
Practice Address - Country:US
Practice Address - Phone:563-332-8528
Practice Address - Fax:563-332-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA059775261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherSOCIAL SECURITY