Provider Demographics
NPI:1033492541
Name:SOUTHEAST IOWA FAMILY PRACTICE OF SIGOURNEY LLC
Entity Type:Organization
Organization Name:SOUTHEAST IOWA FAMILY PRACTICE OF SIGOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:319-461-7130
Mailing Address - Street 1:23019 HIGHWAY 149 LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-8341
Mailing Address - Country:US
Mailing Address - Phone:641-622-1170
Mailing Address - Fax:641-622-1179
Practice Address - Street 1:23019 HIGHWAY 149 LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-8341
Practice Address - Country:US
Practice Address - Phone:641-622-1170
Practice Address - Fax:641-622-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-104668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty