Provider Demographics
NPI:1851082408
Name:LEARAES
Entity Type:Organization
Organization Name:LEARAES
Other - Org Name:RENEW 122 HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHONA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:563-508-3236
Mailing Address - Street 1:122 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2317
Mailing Address - Country:US
Mailing Address - Phone:563-206-1138
Mailing Address - Fax:563-206-1138
Practice Address - Street 1:122 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2317
Practice Address - Country:US
Practice Address - Phone:563-508-3236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service