Individual
JACIE ELAINE VANDER WAAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4163 HICKORY AVE, SIOUX CENTER, IA 51250-7586
(712) 441-2160
Mailing address
4163 HICKORY AVE, SIOUX CENTER, IA 51250-7586
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/22/2026
Last updated
01/22/2026
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