Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | H138622 | IA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 111168 | NE |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A138622 | IA |
NPI | 1285942359 |
---|---|
Provider Name | Ms. Sara Marie Gudenkauf |
First Address | Fort Madison, IA 52627-9601 |
Second Address | Fort Madison, IA 52627-9601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2010 |
Last Update Date | 29/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
098939002 | MEDICARE PTAN (01) | NE |