Healthcare Provider Details

I. General information

NPI: 1215504071
Provider Name (Legal Business Name): MAGGIE BRYNN HEFNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E UNIVERSITY AVE
DES MOINES IA
50316-2304
US

IV. Provider business mailing address

840 E UNIVERSITY AVE
DES MOINES IA
50316-2304
US

V. Phone/Fax

Practice location:
  • Phone: 515-265-4211
  • Fax:
Mailing address:
  • Phone: 515-265-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-12180
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: