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NPI Code Detail

MEDICARE: STACIA NISSEN DIERKS

MEDICARE: STACIA NISSEN DIERKS
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
1225200000XPhysical Therapy Assistant073738IA

General Provider Information

NPI Number : 1376952036
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIA NISSEN DIERKS
Provider Business Mailing Address
First Line : 1801 34TH ST
Second Line :
City : DES MOINES
State : IA
Zip : 50310-5237
Country : US
Telephone Number : 515-571-0640
Fax Number :
Provider Business Practice Location Address
First Line : 3200 WESTOWN PKWY
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-1110
Country : US
Telephone Number : 515-276-1212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2014
Last Update Date : 09/11/2014

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Directions to “ STACIA NISSEN DIERKS ” Practice Location

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