Provider Demographics
NPI:1154823326
Name:HUSTEDT, JILL A (ARNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:HUSTEDT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:337 11TH ST SW
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-5849
Mailing Address - Country:US
Mailing Address - Phone:712-792-7500
Mailing Address - Fax:712-792-7510
Practice Address - Street 1:337 11TH ST SW
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5849
Practice Address - Country:US
Practice Address - Phone:712-792-7500
Practice Address - Fax:712-792-7510
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA102988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner