Basic Information
| Provider Information | |||||||||
| NPI: | 1497743298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ECHTERNACHT | ||||||||
| FirstName: | HARRIET | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2941 SIERRA CT SW | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522408503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193377642 | ||||||||
| FaxNumber: | 3193391449 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 SCOTT BLVD | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522402907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193397472 | ||||||||
| FaxNumber: | 3196882503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 09/17/2009 | ||||||||
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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 | 207Q00000X | 29493 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00028024 | 01 | IA | RR MEDICARE | OTHER | 1497743298 | 05 | IA | MEDICAID | 2092940 | 05 | IA | MEDICAID | 34581 | 01 | IA | WELLMARK BCBS | OTHER |