Basic Information
| Provider Information | |||||||||
| NPI: | 1003461518 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MVP INTEGRATIVE HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 PIERCE STREET | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122550204 | ||||||||
| FaxNumber: | 7122551120 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 PIERCE STREET | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122550204 | ||||||||
| FaxNumber: | 7122551120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2019 | ||||||||
| LastUpdateDate: | 08/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | VANT HUL | ||||||||
| AuthorizedOfficialFirstName: | MARKIE | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | ARNP/ CO-OWNER /PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 7124701498 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 363LP0808X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.