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General NPI Number Information
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NPI Number | 1508305541
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Entity Type | Individual
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Provider Name | LAURA MEDANIC
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Gender | Female
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 1013 PENNSYLVANIA AVE # A-C
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City | OTTUMWA
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State | IA
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Zip | 52501-2110
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Country | US
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Telephone | 641-683-6868
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Fax | 641-683-6869
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Provider Business Mailing Address
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Address Line | 1001 PENNSYLVANIA AVE
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City | OTTUMWA
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State | IA
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Zip | 52501-2186
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Country | US
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Telephone | 641-682-7511
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Fax | 641-684-3199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28212530A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A149465
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License Number State | IA
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