Basic Information
| Provider Information | |||||||||
| NPI: | 1992464325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COVERT | ||||||||
| FirstName: | MARCY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12129 UNIVERSITY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154003550 | ||||||||
| FaxNumber: | 5154003551 | ||||||||
| Practice Location | |||||||||
| Address1: | 12129 UNIVERSITY AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154003550 | ||||||||
| FaxNumber: | 5154003551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2021 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A166656 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.