Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 054146 | GA |
N | 111NI0900X | Internist | 054146 | GA |
N | 207R00000X | Internist | 36574 | IA |
N | 111NI0900X | Internist | 36574 | IA |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD-36574 | IA |
N | 207RC0000X | Internist - Cardiovascular Disease | 36574 | IA |
NPI | 1700808185 |
---|---|
Provider Name | Jennifer L. Goerbig-Campbell |
First Address | Des Moines, IA 50306-9170 |
Second Address | Des Moines, IA 50314-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 14/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I33110 | (02) | GA |