Provider Demographics
NPI:1811278872
Name:WADDELL, JEFFREY M (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:WADDELL
Suffix:
Gender:M
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S STUART ST STE B
Mailing Address - Street 2:
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-1154
Mailing Address - Country:US
Mailing Address - Phone:641-622-1170
Mailing Address - Fax:641-903-7024
Practice Address - Street 1:1314 S STUART ST STE B
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-1154
Practice Address - Country:US
Practice Address - Phone:641-622-1170
Practice Address - Fax:641-903-7024
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75481363L00000X
IAA132444363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner