Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MD-45194 | IA |
NPI | 1114284775 |
---|---|
Provider Name | Carly Anne Theiler |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 13/07/2018 |