Provider Demographics
NPI:1003030966
Name:KOUBA, HALEY (RD)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:KOUBA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5484
Mailing Address - Country:US
Mailing Address - Phone:641-753-4518
Mailing Address - Fax:
Practice Address - Street 1:1301 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5484
Practice Address - Country:US
Practice Address - Phone:641-753-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered