Provider Demographics
NPI:1912645631
Name:MORTENSON, TAMARA ALBRIGHT (ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ALBRIGHT
Last Name:MORTENSON
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:ALBRIGHT
Other - Last Name:MORTENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, FNP-BC
Mailing Address - Street 1:1776 WEST LAKES PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8378
Mailing Address - Country:US
Mailing Address - Phone:515-241-3510
Mailing Address - Fax:847-235-6130
Practice Address - Street 1:1776 WEST LAKES PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8378
Practice Address - Country:US
Practice Address - Phone:515-241-3510
Practice Address - Fax:847-235-6130
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA168885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily