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General NPI Number Information
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NPI Number | 1063758605
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Entity Type | Organization
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Legal Business Name | BLANK CHILDRENS HOSPITAL
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Dates
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Enumeration Date | 01/01/2013
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Last Update Date | 01/01/2013
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Provider Practice Location Address
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Address Line | 6540 NE 12TH AVE
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City | PLEASANT HILL
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State | IA
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Zip | 50327-8828
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Country | US
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Telephone | 515-266-6795
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 PLEASANT ST
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City | DES MOINES
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State | IA
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Zip | 50309-1406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KEN CHEYNE
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Credential |
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Telephone | 515-241-8198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | C-119097
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License Number State | IA
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