Individual
MRS. KELLIE GOEDKEN DEN HARTOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 S 10TH AVE, ROCK RAPIDS, IA 51246-2020
(712) 472-5399
Mailing address
1363 HIGHWAY 9 APT 5, LARCHWOOD, IA 51241-7585
(712) 348-3341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
095185
IA
Other
Enumeration date
02/13/2019
Last updated
02/28/2019
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