Healthcare Provider Details

I. General information

NPI: 1134147127
Provider Name (Legal Business Name): NONA M MEYER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12289 STRATFORD DR SUITE B
CLIVE IA
50325-8167
US

IV. Provider business mailing address

12289 STRATFORD DR SUITE B
CLIVE IA
50325-8167
US

V. Phone/Fax

Practice location:
  • Phone: 515-225-9777
  • Fax: 515-225-9780
Mailing address:
  • Phone: 515-225-9777
  • Fax: 515-225-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00628
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier50570
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUECROSS/BLUESHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: