Healthcare Provider Details

I. General information

NPI: 1932405347
Provider Name (Legal Business Name): LIFE LAUNCH HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 NORTH FIRST STREET
WEST BRANCH IA
52358
US

IV. Provider business mailing address

PO BOX 430
WEST BRANCH IA
52358-0430
US

V. Phone/Fax

Practice location:
  • Phone: 319-248-5370
  • Fax:
Mailing address:
  • Phone: 319-248-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-099076
License Number StateIA

VIII. Authorized Official

Name: EMILY GRIFFIN
Title or Position: NURSE PRACTITIONER
Credential: ARNP
Phone: 319-248-5370