Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | DO-04284 | IA |
NPI | 1144455502 |
---|---|
Provider Name | Dr. Jennifer Ruth Bissing Petts |
First Address | West Des Moines, IA 50266-9313 |
Second Address | West Des Moines, IA 50266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2009 |
Last Update Date | 17/08/2021 |