Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 076492 | IA |
NPI | 1003271636 |
---|---|
Provider Name | Mary Ann Gengler |
First Address | Sioux City, IA 51106-5127 |
Second Address | Sioux City, IA 51106-5127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2015 |
Last Update Date | 17/03/2018 |