MEDICARE: ANNA MARIE DEMPEWOLF PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1008	IA

General Provider Information

NPI Number	:	1124002555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARIE DEMPEWOLF PAC

Provider Business Mailing Address
First Line	:	1307 S BROADWAY ST
Second Line	:
City	:	TOLEDO
State	:	IA
Zip	:	52342-2307
Country	:	US
Telephone Number	:	641-484-5445
Fax Number	:	641-753-2754

Provider Business Practice Location Address
First Line	:	1307 S BROADWAY ST
Second Line	:
City	:	TOLEDO
State	:	IA
Zip	:	52342-2307
Country	:	US
Telephone Number	:	641-484-5445
Fax Number	:	641-753-2754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	10/27/2015

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