Healthcare Provider Details

I. General information

NPI: 1124404272
Provider Name (Legal Business Name): BALANCE INTEGRATIVE HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 ASBURY RD STE #7
DUBUQUE IA
52002-0483
US

IV. Provider business mailing address

4855 ASBURY RD STE 7
DUBUQUE IA
52002-0483
US

V. Phone/Fax

Practice location:
  • Phone: 563-284-2422
  • Fax:
Mailing address:
  • Phone: 563-284-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA122623
License Number StateIA

VIII. Authorized Official

Name: STEPHANIE MARIE GRUTZ
Title or Position: FAMILY NURSE PRACTITIONER
Credential: ARNP
Phone: 563-663-1248