Provider Demographics
NPI:1982106712
Name:BIRD, RAELEE LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:RAELEE
Middle Name:LYNN
Last Name:BIRD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RAELEE
Other - Middle Name:LYNN
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:IA
Mailing Address - Zip Code:52540-0125
Mailing Address - Country:US
Mailing Address - Phone:319-461-6168
Mailing Address - Fax:
Practice Address - Street 1:125 E ZELLER ST STE D
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9248
Practice Address - Country:US
Practice Address - Phone:319-853-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA137415163W00000X
IAH137415363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse