Individual
MS. TERRY M IDEKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
515 E BROADWAY, COUNCIL BLUFFS, IA 51503-4419
(402) 594-1616
(712) 322-6833
Mailing address
515 E BROADWAY, COUNCIL BLUFFS, IA 51503-4419
(712) 322-1347
(712) 322-6833
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
49966
NE
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
G118751
IA
Other
Enumeration date
10/26/2007
Last updated
03/26/2012
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