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Individual

ROBERTA ANN WATTLEWORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
3200 GRAND AVE, DES MOINES, IA 50312-4104
(515) 271-1710
(515) 271-1575
Mailing address
3200 GRAND AVE, DES MOINES, IA 50312-4104
(515) 271-1710
(515) 271-1575

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13248
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080147596
RR MEDICARE
IA
05
1250795
IA
Enumeration date
08/18/2005
Last updated
02/24/2010
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