Healthcare Provider Details

I. General information

NPI: 1437424041
Provider Name (Legal Business Name): CATHERINE E GEHRIS RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 S 1ST AVE
IOWA CITY IA
52245-5208
US

IV. Provider business mailing address

812 S 1ST AVE
IOWA CITY IA
52245-5208
US

V. Phone/Fax

Practice location:
  • Phone: 319-337-4279
  • Fax: 319-338-4642
Mailing address:
  • Phone: 319-337-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00249
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: