1982902789 NPI number — DR. SUSAN MORTWEET VANSCOYOC PH.D.

Table of content: DR. SUSAN MORTWEET VANSCOYOC PH.D. (NPI 1982902789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982902789 NPI number — DR. SUSAN MORTWEET VANSCOYOC PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANSCOYOC
Provider First Name:
SUSAN
Provider Middle Name:
MORTWEET
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORTWEET
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982902789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 E JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52245-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-351-1448
Provider Business Mailing Address Fax Number:
319-351-9367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2591 HOLIDAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORALVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52241-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-339-1231
Provider Business Practice Location Address Fax Number:
319-688-2930
Provider Enumeration Date:
03/03/2011

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: 103T00000X , with the licence number:  001184 , 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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