| Organization Name: | BLANK CHILDRENS HOSPITAL |
| NPI Number: | 1063758605 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEN CHEYNE (PHYSICIAN) |
| Mailing Address: | 6540 Ne 12th Ave Pleasant Hill |
| State: | IA US |
| Postal Code: | 503278828 |
| Phone Number: | 5152666795 |
| Fax Number: | |
| NPI Enumeration Date: | 01/01/2013 |
| NPI Last Update Date: | 01/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | C-119097 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |