| NPI | 1013153436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WILLIAM DETLEFSEN Psychiatric Nurse Practitioner 319-899-2529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IA 115825) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2009-01-07 |