Provider Demographics
NPI:1154637692
Name:KUBIK, JOELLEN CIZEK (ARNP; PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JOELLEN
Middle Name:CIZEK
Last Name:KUBIK
Suffix:
Gender:F
Credentials:ARNP; PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W DALE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1901
Mailing Address - Country:US
Mailing Address - Phone:319-233-3351
Mailing Address - Fax:319-235-3132
Practice Address - Street 1:146 W DALE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1901
Practice Address - Country:US
Practice Address - Phone:319-233-3351
Practice Address - Fax:319-235-3132
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067317363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA533820005OtherMEDICARE PTAN