Basic Information
Provider Information
NPI: 1639545486
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPREACKER
FirstName: MEGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1475
Address2:  
City: DES MOINES
State: IA
PostalCode: 503051475
CountryCode: US
TelephoneNumber: 5156438611
FaxNumber: 5156438812
Practice Location
Address1: 330 LAUREL STREET
Address2: SUITE 2100
City: DES MOINES
State: IA
PostalCode: 503143068
CountryCode: US
TelephoneNumber: 5156438611
FaxNumber: 5156438812
Other Information
ProviderEnumerationDate: 08/17/2015
LastUpdateDate: 08/17/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XC118951IAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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