Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO-03030 | IA |
N | 207Q00000X | Family Doctor | 03030 | IA |
NPI | 1083606735 |
---|---|
Provider Name | Adrian L Woolley |
First Address | Des Moines, IA 50312-4104 |
Second Address | Des Moines, IA 50312-4104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 12/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080128328 | RR MEDICARE (01) | IA |
2142737 | (05) | IA |
G44268 | (02) |