Individual
OMAR ACEVIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1520 W 53RD ST, DAVENPORT, IA 52806-2459
(563) 421-3800
Mailing address
507 41ST AVE, EAST MOLINE, IL 61244-3466
(309) 721-6294
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
143754
IA
363L00000X
Nurse Practitioner
Primary
A174108
IA
Other
Enumeration date
08/22/2022
Last updated
05/03/2023
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