Healthcare Provider Details

I. General information

NPI: 1922665769
Provider Name (Legal Business Name): ALEXANDRA MARIE KOCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA MARIE DONOVAN PA-C

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2421
  • Fax: 319-356-3900
Mailing address:
  • Phone: 319-356-2421
  • Fax: 319-356-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number097411
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: