=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336910793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONOR GREEAR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2024
-----------------------------------------------------
Last Update Date | 01/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1214 DINA CT STE A
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52233-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-405-0624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6913 1ST AVE SW
-----------------------------------------------------
City | CEDAR RAPIDS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52405-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-412-7686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 120230
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------