Provider Demographics
NPI:1184629107
Name:DEFALCO-MCGEEIN, DENISE M (APN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:DEFALCO-MCGEEIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:DEFALCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4480 UTICA RIDGE RD
Mailing Address - Street 2:STE 1140
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1656
Mailing Address - Country:US
Mailing Address - Phone:563-742-5700
Mailing Address - Fax:563-742-5705
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:STE 1140
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1656
Practice Address - Country:US
Practice Address - Phone:563-742-5700
Practice Address - Fax:563-742-5705
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003068363LW0102X
IAF-103719363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1184629107Medicaid
IA719260479Medicare PIN
IA1184629107Medicaid