Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | A106126 | IA |
Y | 363LP1700X | Nurse Practitioner - Perinatal | A106126 | IA |
NPI | 1033200431 |
---|---|
Provider Name | Catherine Wallace |
First Address | Des Moines, IA 50316-2316 |
Second Address | Des Moines, IA 50316-2316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 30/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033200431 | (05) | IA |
IA0104 | JOHN DEERE (01) | IA |