Healthcare Provider Details

I. General information

NPI: 1144591546
Provider Name (Legal Business Name): DR. ANN LEIGH ENNEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 MIDWAY DR NW
CEDAR RAPIDS IA
52405-3506
US

IV. Provider business mailing address

3434 MIDWAY DR NW
CEDAR RAPIDS IA
52405-3506
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-7800
  • Fax: 319-396-3849
Mailing address:
  • Phone: 319-396-7800
  • Fax: 319-396-3849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6420
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: