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General NPI Number Information
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NPI Number | 1952088437
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Entity Type | Individual
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Provider Name | SUSAN MIREMBE MATOVU ARNP
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Gender | Female
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 1801 HICKMAN ROAD
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City | DES MOINES
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State | IA
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Zip | 50314
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Country | US
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Telephone | 515-282-5742
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Fax |
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Provider Business Mailing Address
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Address Line | 920 NE 41ST ST
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City | ANKENY
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State | IA
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Zip | 50021-6710
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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 |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | G175028
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License Number State | IA
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