Individual
SHARON K VANDE VEGTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
700 E 2ND ST, SUITE 2, IDA GROVE, IA 51445-1601
(712) 364-2514
(712) 364-4430
Mailing address
700 E 2ND ST, SUITE 2, IDA GROVE, IA 51445-1601
(712) 364-2514
(712) 364-4430
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03092
IA
207Q00000X
Family Medicine Physician
427
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1139709
—
IA
05
—
2139709
—
IA
05
—
42128384914
—
IA
01
—
49594
WELLMARK
IA
01
—
56248
WELLMARK OF IA
IA
05
—
7701450
—
IA
05
—
7701452
—
SD
Enumeration date
06/14/2006
Last updated
10/02/2014
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