Basic Information
| Provider Information | |||||||||
| NPI: | 1326550922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEAN | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 DOUGLAS AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503102760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5157248920 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5005 DOUGLAS AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503102760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5157248920 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2017 | ||||||||
| LastUpdateDate: | 11/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | 117312 | IA | Y | Nursing Service Providers | Registered Nurse | Pediatrics |
No ID Information.