Basic Information
| Provider Information | |||||||||
| NPI: | 1942713888 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAE | ||||||||
| FirstName: | SHAYLA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 WEDGEWOOD CIR | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525563885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414724156 | ||||||||
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| Practice Location | |||||||||
| Address1: | 931 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | OTTUMWA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525012138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416828761 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2017 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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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 | 163W00000X | 131158 | IA | N | Nursing Service Providers | Registered Nurse | 367A00000X | B131158 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LW0102X | F131158 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.