Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 085842 | IA |
Y | 363LN0000X | Nurse Practitioner - Neonatal | K085842 | IA |
NPI | 1134325764 |
---|---|
Provider Name | Dawn Renee Wanfalt |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70099 | WELLMARK BCBS (01) | IA |