Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | A05777 | IA |
NPI | 1538272638 |
---|---|
Provider Name | Dr. Karen Shoemaker |
First Address | Bettendorf, IA 52722-4403 |
Second Address | Bettendorf, IA 52722-4403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |