Healthcare Provider Details

I. General information

NPI: 1962489021
Provider Name (Legal Business Name): MONICA SUE STEINBORN LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAIN ST
CARROLL IA
51401-2739
US

IV. Provider business mailing address

31786 120TH ST
LOHRVILLE IA
51453-8014
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-4000
  • Fax:
Mailing address:
  • Phone: 712-656-2218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00216
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: