Basic Information
Provider Information
NPI: 1912516881
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUMBURG
FirstName: LAUREN
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: ARNP, DNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2140 53RD AVE
Address2:  
City: BETTENDORF
State: IA
PostalCode: 527226279
CountryCode: US
TelephoneNumber: 5634215700
FaxNumber:  
Practice Location
Address1: 2140 53RD AVE
Address2:  
City: BETTENDORF
State: IA
PostalCode: 527226279
CountryCode: US
TelephoneNumber: 5634215700
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/27/2020
LastUpdateDate: 11/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X209021696ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home