Provider Demographics
NPI:1083609929
Name:WESTENDORF, JEAN L (ARNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:WESTENDORF
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 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401
Mailing Address - Country:US
Mailing Address - Phone:641-428-6900
Mailing Address - Fax:641-428-6909
Practice Address - Street 1:621 S ILLINOIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-428-6900
Practice Address - Fax:641-428-6909
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC039850363L00000X
IA039850363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0425017Medicaid
IA55760OtherWELLMARK BCBS
IA0425017Medicaid