Basic Information
| Provider Information | |||||||||
| NPI: | 1205473808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATCHER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | PHILLIP | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 HACKBERRY ST | ||||||||
| Address2: | |||||||||
| City: | NORTH LIBERTY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523179726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3199317804 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1307 S BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523422307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414845445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2019 | ||||||||
| LastUpdateDate: | 12/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A156476 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.