Individual
MONICA LURSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETICIAN
Contact information
Practice address
312 9TH ST SW, WAVERLY, IA 50677-2929
(319) 352-4902
Mailing address
27924 BUTLER CENTER RD, CLARKSVILLE, IA 50619-9180
(319) 352-4902
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
00410
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00410
IA LICENSE
IA
01
—
368373
CDR
IA
Enumeration date
04/25/2007
Last updated
07/08/2007
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