Healthcare Provider Details

I. General information

NPI: 1295211852
Provider Name (Legal Business Name): URBAN EFFECTS HOLDINGS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 86TH ST
URBANDALE IA
50322-4336
US

IV. Provider business mailing address

500 E COURT AVE STE 305
DES MOINES IA
50309-2057
US

V. Phone/Fax

Practice location:
  • Phone: 515-987-5188
  • Fax: 515-987-8152
Mailing address:
  • Phone: 515-239-3974
  • Fax: 515-237-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA059121
License Number StateIA

VIII. Authorized Official

Name: SUSAN L CROSS
Title or Position: DIRECTOR
Credential: FNP-BC
Phone: 515-987-5188