Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | A064498 | IA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | C064498 | IA |
NPI | 1033437140 |
---|---|
Provider Name | Dr. Teresa Dale Schenck |
First Address | Keokuk, IA 52632 |
Second Address | Keokuk, IA 52632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2010 |
Last Update Date | 23/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MS2158358 | FEDERAL DEA (01) | IA |