Provider Demographics
NPI:1225730088
Name:BEAN, DOUGLAS R (PMH-RN)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:BEAN
Suffix:
Gender:M
Credentials:PMH-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7731 148TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTCH GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:52310-7459
Mailing Address - Country:US
Mailing Address - Phone:319-651-7860
Mailing Address - Fax:
Practice Address - Street 1:601 HIGHWAY 6 W
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2209
Practice Address - Country:US
Practice Address - Phone:319-688-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105357163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management