Healthcare Provider Details

I. General information

NPI: 1245800788
Provider Name (Legal Business Name): TERESA MUNRO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

100 MARKET ST UNIT 118
DES MOINES IA
50309-4762
US

V. Phone/Fax

Practice location:
  • Phone: 543-751-5241
  • Fax:
Mailing address:
  • Phone: 515-249-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC164672
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC164765
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number144460
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: