Provider Demographics
NPI:1376814335
Name:INTEGRATIVE HEALTH AND HORMONE CLINIC, INC.
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH AND HORMONE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:319-329-8132
Mailing Address - Street 1:1731 BOYSON RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2313
Mailing Address - Country:US
Mailing Address - Phone:319-363-0033
Mailing Address - Fax:319-363-4411
Practice Address - Street 1:1731 BOYSON RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2313
Practice Address - Country:US
Practice Address - Phone:319-363-0033
Practice Address - Fax:319-363-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH-117587363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty