Healthcare Provider Details

I. General information

NPI: 1285549444
Provider Name (Legal Business Name): SUSAN DENNIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

1809 W CHEYENNE CT
POLK CITY IA
50226-2126
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number109634
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: