Provider Demographics
NPI:1811748049
Name:IOWA WELLNESS CLINIC PLLC
Entity type:Organization
Organization Name:IOWA WELLNESS CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRASLAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-943-9070
Mailing Address - Street 1:430 B AVE NE
Mailing Address - Street 2:
Mailing Address - City:WALFORD
Mailing Address - State:IA
Mailing Address - Zip Code:52351-8018
Mailing Address - Country:US
Mailing Address - Phone:501-943-9070
Mailing Address - Fax:
Practice Address - Street 1:3555 STONE CREEK CIR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1240
Practice Address - Country:US
Practice Address - Phone:319-693-8800
Practice Address - Fax:319-208-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty