Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | A162118 | IA |
NPI | 1215528823 |
---|---|
Provider Name | Bryce Sunderman |
First Address | Des Moines, IA 50305-1475 |
Second Address | Des Moines, IA 50314-2613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2021 |
Last Update Date | 20/04/2021 |