MEDICARE: WHOLE WOMAN HEALTH LLC

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	F-077227	IA

General Provider Information

NPI Number	:	1346548419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE WOMAN HEALTH LLC

Provider Business Mailing Address
First Line	:	4507 FOREST AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-2446
Country	:	US
Telephone Number	:	515-243-6309
Fax Number	:	515-283-2502

Provider Business Practice Location Address
First Line	:	4507 FOREST AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-2446
Country	:	US
Telephone Number	:	515-243-6309
Fax Number	:	515-283-2502

Authorized Official
Title or Position	:	OWNER
Name	:	LISA KAMPHUIS
Credential	:	ARNP
Telephone Number	:	515-243-6309

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/14/2011

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Directions to “WHOLE WOMAN HEALTH LLC ” Practice Location

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