Basic Information
Provider Information | |||||||||
NPI: | 1013330547 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEDVINA | ||||||||
FirstName: | KRISTIN | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSN, RN, CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BOSWELL | ||||||||
OtherFirstName: | KRISTIN | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MSN, RN, CRNA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2620 SW 20TH CIR | ||||||||
Address2: |   | ||||||||
City: | ANKENY | ||||||||
State: | IA | ||||||||
PostalCode: | 500232295 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5155545777 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 411 LAUREL ST | ||||||||
Address2: | SUITE 3170 | ||||||||
City: | DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 503143017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152830463 | ||||||||
FaxNumber: | 5152830794 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/04/2014 | ||||||||
LastUpdateDate: | 05/08/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 117299 | IA | N |   | Nursing Service Providers | Registered Nurse |   | 367500000X | D117299 | IA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.