| Organization Name: | STATE UNIVERSITY OF IOWA |
| NPI Number: | 1033424650 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILIP E ROUDABUSH (DIRECTOR, PFS) |
| Mailing Address: | 2510 Corridor Way Suite 6a Coralville |
| State: | IA US |
| Postal Code: | 522417604 |
| Phone Number: | 3193848500 |
| Fax Number: | |
| NPI Enumeration Date: | 08/09/2010 |
| NPI Last Update Date: | 03/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |