Healthcare Provider Details

I. General information

NPI: 1457245870
Provider Name (Legal Business Name): MEAGHAN NICOLE GRETEMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 WOODLAND AVE SUITE 140
DES MOINES IA
50309
US

IV. Provider business mailing address

1415 WOODLAND AVE SUITE 140
DES MOINES IA
50309
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-5586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR-13570
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: