Provider Demographics
NPI:1083788996
Name:MCDONALD POLLOCK HEALTH CLINIC
Entity Type:Organization
Organization Name:MCDONALD POLLOCK HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, MSN, FNP
Authorized Official - Phone:319-338-3900
Mailing Address - Street 1:2401 TOWNCREST LN
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6630
Mailing Address - Country:US
Mailing Address - Phone:319-338-3900
Mailing Address - Fax:319-338-3907
Practice Address - Street 1:2401 TOWNCREST LN
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6630
Practice Address - Country:US
Practice Address - Phone:319-338-3900
Practice Address - Fax:319-338-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA102923363LF0000X
IAF077233363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27622OtherBLUE SHIELD
IA27307OtherBLUE SHIELD