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NPI Code Detail

MEDICARE: MISS KYMBERLY ANN WROBLE RD, LD

MEDICARE: MISS KYMBERLY ANN WROBLE RD, LD
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
1133V00000XRegistered Dietitian001865IA

General Provider Information

NPI Number : 1447524962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KYMBERLY ANN WROBLE RD, LD
Provider Business Mailing Address
First Line : 545 PENN CT
Second Line : UNIT 11
City : NORTH LIBERTY
State : IA
Zip : 52317-9668
Country : US
Telephone Number : 309-781-8259
Fax Number : 319-354-5410
Provider Business Practice Location Address
First Line : 1720 WATERFRONT DR
Second Line :
City : IOWA CITY
State : IA
Zip : 52240-4414
Country : US
Telephone Number : 319-354-7601
Fax Number : 319-354-5410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2012
Last Update Date : 03/01/2012

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