Doctor Name: | BILLIE L TACK |
NPI Number: | 1003866674 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | F-067399 |
Business Practice Address: | 915 13th Ave N Clinton, IA - 527325067 |
Business Phone Number: | 5632462511 |
Business Fax Number: | 5632430817 |
Mailing Address: | 915 13th Ave N, CLINTON |
State: | IA |
Postal Code: | 527325067 |
Phone Number: | 5632462511 |
Fax Number: | 5632430817 |
NPI Enumeration Date: | 05/12/2006 |
NPI Last Update Date: | 09/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | F-067399 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |