Basic Information
| Provider Information | |||||||||
| NPI: | 1578944476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PASSINI | ||||||||
| FirstName: | ANN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2140 53RD AVE | ||||||||
| Address2: | |||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527226279 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2140 53RD AVE | ||||||||
| Address2: | |||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634215700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2015 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-10388 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R-10767 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO-05172 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.