Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MD-42722 | IA |
NPI | 1184980278 |
---|---|
Provider Name | Morgan Leigh Grundstad |
First Address | Des Moines, IA 50314-2613 |
Second Address | Des Moines, IA 50314-2611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 24/04/2019 |