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NPI Code Detail

MEDICARE: MRS. DONNA L VAN PEURSEM LISW

MEDICARE: MRS. DONNA L VAN PEURSEM LISW
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
11041C0700XClinical Social Worker06099IA

General Provider Information

NPI Number : 1740256718
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA L VAN PEURSEM LISW
Provider Business Mailing Address
First Line : 1905 10TH ST
Second Line : PO BOX 163
City : ROCK VALLEY
State : IA
Zip : 51247-1630
Country : US
Telephone Number : 712-476-5245
Fax Number : 712-476-9621
Provider Business Practice Location Address
First Line : 1905 10TH ST
Second Line :
City : ROCK VALLEY
State : IA
Zip : 51247-1630
Country : US
Telephone Number : 712-476-5245
Fax Number : 712-476-9621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. DONNA L VAN PEURSEM LISW” Practice Location

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