Organization
PRUCHNO MEDICINE LLC. / HEALTH TRANSITIONS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM A. CLAYTON (OFFICE MANAGER)
(319) 247-3894
Entity
Organization
Contact information
Practice address
202 10TH ST SE, CEDAR RAPIDS, IA 52403-2414
(319) 247-3894
Mailing address
202 10TH ST SE, CEDAR RAPIDS, IA 52403-2414
(319) 247-3894
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
079549
IA
133V00000X
Registered Dietitian
079549
IA
133VN1005X
Renal Nutrition Registered Dietitian
Primary
079549
IA
133VN1006X
Metabolic Nutrition Registered Dietitian
079549
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1101865
—
IA
Enumeration date
03/30/2017
Last updated
03/30/2017
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