Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A080263 | IA |
N | 363L00000X | Nurse Practitioner | A080263 | IA |
N | 363LC1500X | Nurse Practitioner - Community Health | A080263 | IA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | A080263 | IA |
NPI | 1821196700 |
---|---|
Provider Name | Theresa A Ledesma |
First Address | Waterloo, IA 50702-5401 |
Second Address | Oelwein, IA 50662-2447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 05/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0074625 | (05) | IA |
P16372 | (02) | IA |