Provider Demographics
NPI:1033107768
Name:DEARDORFF, DONNA LEE (CNM, ARNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:DEARDORFF
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:DEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, ARNP
Mailing Address - Street 1:1015 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5733
Mailing Address - Country:US
Mailing Address - Phone:515-239-4404
Mailing Address - Fax:515-239-4786
Practice Address - Street 1:1015 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5733
Practice Address - Country:US
Practice Address - Phone:515-239-4404
Practice Address - Fax:515-239-4786
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB060920367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419572Medicaid
IAS91875Medicare UPIN
IA04907Medicare ID - Type Unspecified