Healthcare Provider Details

I. General information

NPI: 1376268565
Provider Name (Legal Business Name): SARAH JESSICA SEUNTJENS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

146 W DALE ST STE 102
WATERLOO IA
50703-1901
US

IV. Provider business mailing address

5100 PRAIRIE PKWY STE 201
CEDAR FALLS IA
50613-8155
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberB171303
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: