Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 29496 | IA |
NPI | 1255325130 |
---|---|
Provider Name | Karen J Gerdes |
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 | 07/09/2005 |
Last Update Date | 03/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101477 | (05) | IA |
F64481 | (02) |