Healthcare Provider Details

I. General information

NPI: 1790805802
Provider Name (Legal Business Name): JULIA BASS 116545
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HIGHWAY 6 W
IOWA CITY IA
52246-2292
US

IV. Provider business mailing address

2043 JASPER AVE
MUSCATINE IA
52761-8788
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number116545
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: