Healthcare Provider Details

I. General information

NPI: 1689667784
Provider Name (Legal Business Name): JANICE MAUREEN PLEGGENKUHLE RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W 1ST ST COMMUNITY MEMORIAL HOSPITAL
SUMNER IA
50674-1203
US

IV. Provider business mailing address

19518 210TH ST
HAWKEYE IA
52147-8217
US

V. Phone/Fax

Practice location:
  • Phone: 563-578-3275
  • Fax: 563-578-3279
Mailing address:
  • Phone: 563-427-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: