Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A134262 | IA |
NPI | 1003303165 |
---|---|
Provider Name | Summer Morgan Lenth |
First Address | Waterloo, IA 50702-5619 |
Second Address | Waterloo, IA 50702-5619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2018 |
Last Update Date | 15/04/2018 |