Provider Demographics
NPI:1831265305
Name:EINWALTER, KIERAN ANN (ARNP)
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:ANN
Last Name:EINWALTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:STE L
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-955-8326
Mailing Address - Fax:515-574-5508
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:STE L
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-955-8326
Practice Address - Fax:515-574-5508
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA047996363L00000X
IAC047996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55723OtherWELLMARK BCBS
IA55723OtherWELLMARK BCBS
IAI19955Medicare PIN