Provider Demographics
NPI:1528633740
Name:ANKENY INTEGRATIVE HEALTH, PLLC
Entity type:Organization
Organization Name:ANKENY INTEGRATIVE HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:515-964-9966
Mailing Address - Street 1:210 NE DELAWARE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6714
Mailing Address - Country:US
Mailing Address - Phone:515-964-9966
Mailing Address - Fax:
Practice Address - Street 1:210 NE DELAWARE AVE STE 110
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-6714
Practice Address - Country:US
Practice Address - Phone:515-964-9966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty