Healthcare Provider Details

I. General information

NPI: 1457647257
Provider Name (Legal Business Name): MS. LAURA K LEVERENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12499 UNIVERSITY AVE STE 200
CLIVE IA
50325-8288
US

IV. Provider business mailing address

12499 UNIVERSITY AVE STE 200
CLIVE IA
50325-8288
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002214
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: