Healthcare Provider Details

I. General information

NPI: 1538620844
Provider Name (Legal Business Name): PAUL M ROBERTS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6611
  • Fax: 515-241-6635
Mailing address:
  • Phone: 515-241-6611
  • Fax: 515-241-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number102334
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC155676
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: