Provider Demographics
NPI:1033552070
Name:DEBLOIS, JESSICA L (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DEBLOIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N CENTER POINT RD STE C
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1237
Mailing Address - Country:US
Mailing Address - Phone:319-362-0200
Mailing Address - Fax:319-399-5186
Practice Address - Street 1:1001 N CENTER POINT RD STE C
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1237
Practice Address - Country:US
Practice Address - Phone:319-362-0200
Practice Address - Fax:319-399-5186
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1033552070Medicaid
IA71926103Medicare PIN
IAIB2976046Medicare PIN