Healthcare Provider Details

I. General information

NPI: 1255661864
Provider Name (Legal Business Name): MEGAN MARIE RADDATZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN M SORENSEN

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 10TH STREET SE
CEDAR RAPIDS IA
52403-2404
US

IV. Provider business mailing address

PO BOX 3178
CEDAR RAPIDS IA
52406-3178
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-1721
  • Fax: 319-399-2016
Mailing address:
  • Phone: 319-398-1583
  • Fax: 319-399-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number117613
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number363L00000X
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: