Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP2184 | MN |
Y | 103T00000X | Psychologist | LP2184 | MN |
NPI | 1013070721 |
---|---|
Provider Name | Ms. Denise Bowen Iverson |
First Address | East Gull Lake, MN 56401-3094 |
Second Address | Brainerd, MN 56401-2902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012382 | PREFERRED ONE INSURANCE (01) | MN |
126409 | BHP - UCARE INSURANCE (01) | MN |
2H892IV | BCBS INSURANCE (01) | MN |
62-12835 | MEDICA INSURANCE (01) | MN |
HP25546 | HEALTH PARTNERS INSURANCE (01) | MN |