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General NPI Number Information
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NPI Number | 1871350868
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Entity Type | Organization
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Legal Business Name | DRIFTLESS SKIN CENTER, P.C.
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 1550 UNIVERSITY AVE STE B
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City | DUBUQUE
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State | IA
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Zip | 52001-4790
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Country | US
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Telephone | 563-900-8922
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 UNIVERSITY AVE STE B
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City | DUBUQUE
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State | IA
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Zip | 52001-4790
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Country | US
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Telephone | 563-900-8922
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT/OWNER
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Name | MEGAN MOSER EISEL
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Credential | PA-C
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Telephone | 563-900-8922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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