Healthcare Provider Details

I. General information

NPI: 1558069807
Provider Name (Legal Business Name): SKYLAR DAWN POFFENBERGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 SHILOH ROSE PKWY SW
BONDURANT IA
50035-1450
US

IV. Provider business mailing address

264 SHILOH ROSE PKWY SW
BONDURANT IA
50035-1450
US

V. Phone/Fax

Practice location:
  • Phone: 515-650-0378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number154738
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: