Healthcare Provider Details

I. General information

NPI: 1730018979
Provider Name (Legal Business Name): LILY POKORNOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12499 UNIVERSITY AVE STE 200
CLIVE IA
50325-8288
US

IV. Provider business mailing address

6201 EP TRUE PKWY APT 5309
WEST DES MOINES IA
50266-5208
US

V. Phone/Fax

Practice location:
  • Phone: 515-418-9960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number138321
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: