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General NPI Number Information
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NPI Number | 1841249687
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Entity Type | Organization
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Legal Business Name | STATE UNIVERSITY OF IOWA
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 109 W JAYNE ST
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City | LONE TREE
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State | IA
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Zip | 52755-7771
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Country | US
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Telephone | 319-629-4214
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HAWKINS DR
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City | IOWA CITY
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State | IA
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Zip | 52242-1007
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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 | DIRECTOR JOPFS
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Name | SHERRI A STECKROTH
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Credential |
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Telephone | 319-356-3486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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