Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A108113 | IA |
NPI | 1003184599 |
---|---|
Provider Name | Megan Renee Eastman |
First Address | West Des Moines, IA 50266-8209 |
Second Address | Fort Dodge, IA 50501-5776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2011 |
Last Update Date | 12/12/2011 |