Provider Demographics
NPI:1275511230
Name:DEBONIS, RUSELLE SUE (ARNP)
Entity Type:Individual
Prefix:
First Name:RUSELLE
Middle Name:SUE
Last Name:DEBONIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RUSELLE
Other - Middle Name:SUE
Other - Last Name:SAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1015 S HACKETT RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701
Mailing Address - Country:US
Mailing Address - Phone:319-274-1000
Mailing Address - Fax:319-292-6526
Practice Address - Street 1:1015 S HACKETT RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-274-1000
Practice Address - Fax:319-292-6526
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA059613363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA29120OtherBC/BS
IA1275511230Medicaid
IAP00819155OtherRR MEDICARE
IA42137207611OtherJOHN DEERE
IAP54581Medicare UPIN
IA29120OtherBC/BS
IAI3355Medicare ID - Type Unspecified