Provider Demographics
NPI:1326166380
Name:PEDERSEN, DOREEN A (RN)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:A
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4436
Mailing Address - Country:US
Mailing Address - Phone:712-262-2922
Mailing Address - Fax:712-262-3826
Practice Address - Street 1:824 FLINDT DR
Practice Address - Street 2:SUITE 103
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3208
Practice Address - Country:US
Practice Address - Phone:712-732-3736
Practice Address - Fax:712-732-3275
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087128163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse