Healthcare Provider Details

I. General information

NPI: 1790258838
Provider Name (Legal Business Name): MISS ALYSSA ELIZABETH HOEPPNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 COURT AVE
MARENGO IA
52301-1439
US

IV. Provider business mailing address

3726 QUEEN CT SW STE 103
CEDAR RAPIDS IA
52404-3903
US

V. Phone/Fax

Practice location:
  • Phone: 319-642-3031
  • Fax: 319-343-1059
Mailing address:
  • Phone: 319-361-6529
  • Fax: 319-343-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: