Healthcare Provider Details

I. General information

NPI: 1649747247
Provider Name (Legal Business Name): VIVE IV THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
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 Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GRUTZ
Title or Position: OWNER
Credential: ARNP
Phone: 563-284-2422