Provider Demographics
NPI:1053627182
Name:NEUROPSYCHIATRIC MEDICINE CLINIC PLLC
Entity Type:Organization
Organization Name:NEUROPSYCHIATRIC MEDICINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NNANJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-217-2566
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0321
Mailing Address - Country:US
Mailing Address - Phone:319-217-2566
Mailing Address - Fax:
Practice Address - Street 1:511 S 3RD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4357
Practice Address - Country:US
Practice Address - Phone:319-217-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA276922084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID27692OtherIOWA LICENSE