Individual
KATIE C IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
502 N 9TH AVE, VINTON, IA 52349-2254
(319) 472-6200
Mailing address
5167 WESTLAWN, IOWA CITY, IA 52242-1100
(319) 353-5388
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001583
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03137
WELLMARK BCBS
IA
Enumeration date
10/05/2005
Last updated
08/27/2012
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