Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A124824 | IA |
NPI | 1003315201 |
---|---|
Provider Name | Abigail Behrens |
First Address | Carroll, IA 51401-3038 |
Second Address | Denison, IA 51442-2139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2018 |
Last Update Date | 02/02/2018 |