Provider Demographics
NPI:1336144195
Name:GEORGE, JENNIFER A (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:GEORGE
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 1:4321 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1269
Mailing Address - Country:US
Mailing Address - Phone:563-421-5300
Mailing Address - Fax:563-421-5319
Practice Address - Street 1:4321 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1269
Practice Address - Country:US
Practice Address - Phone:563-421-5300
Practice Address - Fax:563-421-5319
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA098358363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
187972OtherIOWA HEALTH SOLUTIONS
41942OtherWELLMARK BC/BS
068802OtherHEALTH ALLIANCE
4786890004OtherDMERC
IA0419689Medicaid
IA0163OtherJOHN DEERE HEALTH PLAN
068802OtherHEALTH ALLIANCE
P40989Medicare UPIN