Provider Demographics
NPI:1346548419
Name:WHOLE WOMAN HEALTH LLC
Entity Type:Organization
Organization Name:WHOLE WOMAN HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMPHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:515-243-6309
Mailing Address - Street 1:4507 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2446
Mailing Address - Country:US
Mailing Address - Phone:515-243-6309
Mailing Address - Fax:515-283-2502
Practice Address - Street 1:4507 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-2446
Practice Address - Country:US
Practice Address - Phone:515-243-6309
Practice Address - Fax:515-283-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-077227363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty