Provider Demographics
NPI:1225025885
Name:BOUSKA, MARGARET L (PA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:BOUSKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2510 CORRIDOR WAY
Practice Address - Street 2:STE 6A
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-7604
Practice Address - Country:US
Practice Address - Phone:319-384-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46835OtherWELLMARK BCBS
S64744Medicare UPIN
IA46835OtherWELLMARK BCBS
IA46835Medicare PIN
IA970007960Medicare PIN