Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | K155446 | IA |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | K155446 | IA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | K155446 | IA |
NPI | 1184270506 |
---|---|
Provider Name | Lisa E Koonce |
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 | 12/08/2019 |
Last Update Date | 12/08/2019 |