Individual
STACIA NISSEN DIERKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3200 WESTOWN PKWY, WEST DES MOINES, IA 50266-1110
(515) 276-1212
Mailing address
1801 34TH ST, DES MOINES, IA 50310-5237
(515) 571-0640
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
073738
IA
Other
Enumeration date
08/07/2014
Last updated
09/11/2014
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