Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 60363825 | WA |
N | 208600000X | Surgeon | 60363825 | WA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD-47394 | IA |
NPI | 1073855128 |
---|---|
Provider Name | Kelly Danielle Ledbetter |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 28/09/2020 |