Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 34940 | IA |
N | 207RH0002X | Hospice and Palliative Medicine | 34940 | IA |
NPI | 1134196025 |
---|---|
Provider Name | Michelle Therese Weckmann |
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 | 01/03/2006 |
Last Update Date | 01/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2433748 | (05) | IA |
55727 | WELLMARK BCBS (01) | IA |
I02060 | (02) |