Provider Demographics
NPI:1023727567
Name:VAN ALLEN, ROSS
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:VAN ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S 1ST AVE STE 25A
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6036
Mailing Address - Country:US
Mailing Address - Phone:319-849-8114
Mailing Address - Fax:
Practice Address - Street 1:1700 S 1ST AVE STE 25A
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6036
Practice Address - Country:US
Practice Address - Phone:319-849-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG171974363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health