MEDICARE: LISA KAMPHUIS ARNP

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	363L00000X	Nurse Practitioner	077227	IA

General Provider Information

NPI Number	:	1861489486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KAMPHUIS ARNP

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	09/27/2010

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