Healthcare Provider Details

I. General information

NPI: 1326009341
Provider Name (Legal Business Name): PINES HEALTHCARE FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ASBURY RD
DUBUQUE IA
52001-3091
US

IV. Provider business mailing address

2100 ASBURY RD
DUBUQUE IA
52001-3091
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-9663
  • Fax: 563-587-0496
Mailing address:
  • Phone: 563-557-9663
  • Fax: 563-587-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL J BOHLE
Title or Position: MD
Credential: MD
Phone: 563-557-9663