Healthcare Provider Details

I. General information

NPI: 1174037188
Provider Name (Legal Business Name): KYLEE KAE ZOSKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 W BENTON ST UNIT 202
IOWA CITY IA
52246-4949
US

IV. Provider business mailing address

1848 W BENTON ST UNIT 202
IOWA CITY IA
52246-4949
US

V. Phone/Fax

Practice location:
  • Phone: 641-858-6538
  • Fax:
Mailing address:
  • Phone: 641-858-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: