| NPI | 1194991109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROB FORNOFF Owner 515-255-3181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2020-12-10 |