Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 25939 | IA |
NPI | 1023092129 |
---|---|
Provider Name | Holley A Bzdega |
First Address | Des Moines, IA 50309-1406 |
Second Address | Des Moines, IA 50309-1406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0042283 | (05) | IA |
A03378 | (02) |