Basic Information
Provider Information | |||||||||
NPI: | 1134187305 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CORNWELL | ||||||||
FirstName: | JOYCE | ||||||||
MiddleName: | RUTH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SZCZEPANOWSKI | ||||||||
OtherFirstName: | JOYCE | ||||||||
OtherMiddleName: | RUTH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ARNP | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 2213 GRAND AVE | ||||||||
Address2: |   | ||||||||
City: | DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 503125305 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152373974 | ||||||||
FaxNumber: | 5158832692 | ||||||||
Practice Location | |||||||||
Address1: | 1600 DIAMOND ST | ||||||||
Address2: |   | ||||||||
City: | ONAWA | ||||||||
State: | IA | ||||||||
PostalCode: | 510401548 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7124232231 | ||||||||
FaxNumber: | 7124233500 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/03/2006 | ||||||||
LastUpdateDate: | 03/12/2008 | ||||||||
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 | 21696-MULTI STATE | NE | N |   | Nursing Service Providers | Registered Nurse |   | 363L00000X | A100852 | IA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 363L00000X | 110134 | NE | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.