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General NPI Number Information
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NPI Number | 1962510099
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Entity Type | Individual
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Provider Name | RENEE R ELLERBROEK MD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 4637 121ST ST
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City | URBANDALE
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State | IA
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Zip | 50323-2311
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Country | US
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Telephone | 515-655-7080
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Fax | 515-655-7090
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Provider Business Mailing Address
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Address Line | 4637 121ST ST
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City | URBANDALE
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State | IA
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Zip | 50323-2311
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Country | US
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Telephone | 515-655-7080
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Fax | 515-655-7090
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 24490
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License Number State | IA
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