Healthcare Provider Details

I. General information

NPI: 1811748049
Provider Name (Legal Business Name): IOWA WELLNESS CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 STONE CREEK CIR SW
CEDAR RAPIDS IA
52404-1240
US

IV. Provider business mailing address

430 B AVE NE
WALFORD IA
52351-8018
US

V. Phone/Fax

Practice location:
  • Phone: 319-693-8800
  • Fax: 319-208-2273
Mailing address:
  • Phone: 501-943-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNON MARIE BRASLAVSKY
Title or Position: OWNER
Credential: APRN
Phone: 501-943-9070