Provider Demographics
NPI:1457647257
Name:LEVERENZ, LAURA K
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:K
Last Name:LEVERENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 WESTOWN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1425
Mailing Address - Country:US
Mailing Address - Phone:515-991-6790
Mailing Address - Fax:515-401-1313
Practice Address - Street 1:2425 WESTOWN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1425
Practice Address - Country:US
Practice Address - Phone:515-991-6790
Practice Address - Fax:515-401-1313
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant