Provider Demographics
NPI:1306566328
Name:ALTRUITY HEALTHCARE AND WELLNESS
Entity type:Organization
Organization Name:ALTRUITY HEALTHCARE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP, FNP-BC, CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-822-0081
Mailing Address - Street 1:1212 W MARION ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-2314
Mailing Address - Country:US
Mailing Address - Phone:563-822-0081
Mailing Address - Fax:563-822-1052
Practice Address - Street 1:1212 W MARION ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-2314
Practice Address - Country:US
Practice Address - Phone:563-822-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2021182987OtherANCC BOARD CERTIFIED
IA15475326OtherCAQH
IA1598423774OtherNPI PERSONAL, PROFESSIONAL
IAA166588OtherFAMILY NURSE PRACTITIONER
IAA166588OtherFAMILY NURSE PRACTITIONER