Healthcare Provider Details

I. General information

NPI: 1770558025
Provider Name (Legal Business Name): DENISE L HONNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE REIFKE P.A.

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 2ND AVE
COUNCIL BLUFFS IA
51501
US

IV. Provider business mailing address

818 5TH AVE STE 200
DES MOINES IA
50309-1303
US

V. Phone/Fax

Practice location:
  • Phone: 877-811-7526
  • Fax: 515-280-7525
Mailing address:
  • Phone: 877-811-7526
  • Fax: 515-280-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001569
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: