Provider Demographics
NPI:1164494308
Name:DEETS, JANE K (ARNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:K
Last Name:DEETS
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 1:1117 CROSSINGS CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7232
Mailing Address - Country:US
Mailing Address - Phone:319-378-3770
Mailing Address - Fax:
Practice Address - Street 1:710 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1544
Practice Address - Country:US
Practice Address - Phone:641-332-2201
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA045230363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0105OtherJOHN DEERE
IA35365OtherWELLMARK
IA0298547Medicaid
IA0298547Medicaid
IAI10455Medicare ID - Type Unspecified