Healthcare Provider Details

I. General information

NPI: 1548632615
Provider Name (Legal Business Name): EVIZZIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 WESTOWN PKWY SUITE 220
WEST DES MOINES IA
50266-1314
US

IV. Provider business mailing address

2829 WESTOWN PKWY SUITE 220
WEST DES MOINES IA
50266-1314
US

V. Phone/Fax

Practice location:
  • Phone: 855-270-3625
  • Fax: 888-972-4901
Mailing address:
  • Phone: 855-270-3625
  • Fax: 888-972-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DOUG WILSON
Title or Position: PRESIDENT
Credential:
Phone: 515-979-5460