Provider Demographics
NPI:1497743298
Name:ECHTERNACHT, HARRIET J (MD)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:J
Last Name:ECHTERNACHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 SIERRA CT SW
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-8503
Mailing Address - Country:US
Mailing Address - Phone:319-337-7642
Mailing Address - Fax:319-339-1449
Practice Address - Street 1:1130 SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-2907
Practice Address - Country:US
Practice Address - Phone:319-339-7472
Practice Address - Fax:319-688-2503
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00028024OtherRR MEDICARE
IA1497743298Medicaid
IA2092940Medicaid
IA34581OtherWELLMARK BCBS
IA2092940Medicaid
IA1497743298Medicaid
IAI9960Medicare PIN