Healthcare Provider Details

I. General information

NPI: 1770421307
Provider Name (Legal Business Name): MISS AUBREY MCENROE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GRAND AVE FL 7
DES MOINES IA
50312-4198
US

IV. Provider business mailing address

3200 GRAND AVE FL 7
DES MOINES IA
50312-4198
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-1716
  • Fax:
Mailing address:
  • Phone: 515-271-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number103
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: