Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 31987 | IA |
N | 208600000X | Surgeon | 31987 | IA |
Y | 2086S0102X | Surgical Critical Care | 31987 | IA |
NPI | 1346242906 |
---|---|
Provider Name | Lucy A Wibbenmeyer |
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 | 12/08/2005 |
Last Update Date | 19/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0155291 | (05) | IA |
40055 | WELLMARK BCBS (01) | IA |
G35059 | (02) |