Healthcare Provider Details

I. General information

NPI: 1447741129
Provider Name (Legal Business Name): MEGAN NICOLE WEEMS WUBBEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 9TH ST
CORALVILLE IA
52241-2209
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-2000
  • Fax: 319-467-2410
Mailing address:
  • Phone: 319-467-2000
  • Fax: 319-467-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-49465
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: