Provider Demographics
NPI:1205992724
Name:SMITH, LOUISE W (ARNP)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:RUTH WIKERT
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-0566
Mailing Address - Fax:319-356-7776
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-0566
Practice Address - Fax:319-356-7776
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA054285363L00000X
IAC054285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0440354Medicaid
IA36769OtherWELLMARK BCBS
Q19775Medicare UPIN
IA36769OtherWELLMARK BCBS