Provider Demographics
NPI:1427910918
Name:VANDERGAAST, MARIELLA ANN (RN)
Entity type:Individual
Prefix:
First Name:MARIELLA
Middle Name:ANN
Last Name:VANDERGAAST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1205
Mailing Address - Country:US
Mailing Address - Phone:319-688-3383
Mailing Address - Fax:319-688-3425
Practice Address - Street 1:2213 2ND ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1205
Practice Address - Country:US
Practice Address - Phone:319-688-3383
Practice Address - Fax:319-688-3425
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA133097163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult