Provider Demographics
NPI:1124006861
Name:TRUESDELL, CATHERINE C (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:TRUESDELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-4300
Mailing Address - Fax:515-241-4359
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 170
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-4300
Practice Address - Fax:515-241-4359
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1124006861Medicaid
IA1122549Medicaid
IA0122549Medicaid
IA59443Medicare PIN
IA1124006861Medicaid