1508079849 NPI number — DEBRA ANN POPPE P.T.

Table of content: DEBRA ANN POPPE P.T. (NPI 1508079849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508079849 NPI number — DEBRA ANN POPPE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POPPE
Provider First Name:
DEBRA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIDENOUR
Provider Other First Name:
DEBRA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508079849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 PLEASANT ST
Provider Second Line Business Mailing Address:
SOUTH 2 ROOM 236
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-241-6228
Provider Business Mailing Address Fax Number:
515-241-8685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 S ANKENY BLVD
Provider Second Line Business Practice Location Address:
BUILDING 5
Provider Business Practice Location Address City Name:
ANKENY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50023-8995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-289-9541
Provider Business Practice Location Address Fax Number:
515-446-3642
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  01224 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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