Healthcare Provider Details

I. General information

NPI: 1336330943
Provider Name (Legal Business Name): STATE UNIVERSITY OF IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NEWTON ROAD 101 CNB
IOWA CITY IA
52242-1121
US

IV. Provider business mailing address

50 NEWTON ROAD 101 CNB
IOWA CITY IA
52242-1121
US

V. Phone/Fax

Practice location:
  • Phone: 319-248-1267
  • Fax: 888-674-8344
Mailing address:
  • Phone: 319-248-1267
  • Fax: 888-674-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDREA P. GREATHOUSE
Title or Position: ADMINISTRATOR
Credential: RHIT
Phone: 319-248-1267