Provider Demographics
NPI:1912901703
Name:WATERLOO VISITING NURSING ASSOCIATION
Entity Type:Organization
Organization Name:WATERLOO VISITING NURSING ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-235-6201
Mailing Address - Street 1:2530 UNIVERSITY AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3304
Mailing Address - Country:US
Mailing Address - Phone:319-235-6201
Mailing Address - Fax:319-232-7296
Practice Address - Street 1:2530 UNIVERSITY AVE
Practice Address - Street 2:STE 3
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3304
Practice Address - Country:US
Practice Address - Phone:319-235-6201
Practice Address - Fax:319-232-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670034Medicaid
IA0670034Medicaid