Basic Information
Provider Information | |||||||||
NPI: | 1851347694 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TURNER | ||||||||
FirstName: | MARY | ||||||||
MiddleName: | CATHRYN | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LOVE | ||||||||
OtherFirstName: | MARY | ||||||||
OtherMiddleName: | CATHRYN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 200 HAWKINS DR | ||||||||
Address2: |   | ||||||||
City: | IOWA CITY | ||||||||
State: | IA | ||||||||
PostalCode: | 522421007 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3193562633 | ||||||||
FaxNumber: | 3193562940 | ||||||||
Practice Location | |||||||||
Address1: | 200 HAWKINS DR | ||||||||
Address2: |   | ||||||||
City: | IOWA CITY | ||||||||
State: | IA | ||||||||
PostalCode: | 522421007 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3193562633 | ||||||||
FaxNumber: | 3193562940 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/25/2006 | ||||||||
LastUpdateDate: | 09/29/2010 | ||||||||
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 | 367500000X | 252910 | TX | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | D108462 | IA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 41102 | 01 |   | AANA NUMBER | OTHER | 252910 | 01 | TX | RN | OTHER |