1891923421 NPI number — JUDITH L. NAYERI, D.O., P.C.

Table of content: (NPI 1891923421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891923421 NPI number — JUDITH L. NAYERI, D.O., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUDITH L. NAYERI, D.O., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891923421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2213 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50312-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-237-3974
Provider Business Mailing Address Fax Number:
515-883-2692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 22ND ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-440-6622
Provider Business Practice Location Address Fax Number:
515-440-6698
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NAYERI
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
515-250-4836

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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