Healthcare Provider Details

I. General information

NPI: 1720705114
Provider Name (Legal Business Name): FRONTLINE DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 4TH AVE E
NEWTON IA
50208-3155
US

IV. Provider business mailing address

300 N 4TH AVE E
NEWTON IA
50208-3155
US

V. Phone/Fax

Practice location:
  • Phone: 641-791-4800
  • Fax: 641-792-4800
Mailing address:
  • Phone: 641-791-4800
  • Fax: 641-792-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSA STOCKER
Title or Position: OWNER/PROVIDER
Credential: ARNP
Phone: 515-865-4291