Healthcare Provider Details

I. General information

NPI: 1336633346
Provider Name (Legal Business Name): ON WITH LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 09/18/2023
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 SW ANKENY RD
ANKENY IA
50023-5999
US

IV. Provider business mailing address

715 SW ANKENY RD
ANKENY IA
50023-5999
US

V. Phone/Fax

Practice location:
  • Phone: 515-289-9662
  • Fax: 515-289-9649
Mailing address:
  • Phone: 515-289-9662
  • Fax: 515-289-9649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ERIN LUFT-WISKUS
Title or Position: CREDENTIALING
Credential:
Phone: 515-289-9703