Provider Demographics
NPI:1326021387
Name:DIRKS, MARY SUSAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUSAN
Last Name:DIRKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:50 NEWTON ROAD
Practice Address - Street 2:COLLEGE OF NURSING- 101 NURSING BLDG
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1121
Practice Address - Country:US
Practice Address - Phone:319-335-9654
Practice Address - Fax:319-335-7106
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082237363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics