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General NPI Number Information
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NPI Number | 1346548419
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Entity Type | Organization
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Legal Business Name | WHOLE WOMAN HEALTH LLC
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 4507 FOREST AVE
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City | DES MOINES
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State | IA
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Zip | 50311-2446
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Country | US
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Telephone | 515-243-6309
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Fax | 515-283-2502
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Provider Business Mailing Address
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Address Line | 4507 FOREST AVE
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City | DES MOINES
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State | IA
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Zip | 50311-2446
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Country | US
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Telephone | 515-243-6309
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Fax | 515-283-2502
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Authorized Official
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Title or Position | OWNER
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Name | LISA KAMPHUIS
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Credential | ARNP
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Telephone | 515-243-6309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | F-077227
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License Number State | IA
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