Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 04258 | IA |
NPI | 1114900214 |
---|---|
Provider Name | Dr. Lloyd Alan Mietzner |
First Address | Bloomfield, IA 52537-1343 |
Second Address | Bloomfield, IA 52537-1343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0043257 | (05) | IA |
04325 | PROVIDER ID (01) | IA |
1043257 | (05) | IA |
29638 | PROVIDER ID (01) | IA |