Basic Information
| Provider Information | |||||||||
| NPI: | 1255823506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELAGARDELLE | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4250 LAFAYETTE RD | ||||||||
| Address2: | |||||||||
| City: | EVANSDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507071226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192693374 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3251 W 9TH ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192342893 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2018 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | G139136 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.