Provider Demographics
NPI:1366858334
Name:DUYVEJONCK, ALICIA L (DNP, AGNP, NP-C, AQH)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:L
Last Name:DUYVEJONCK
Suffix:
Gender:F
Credentials:DNP, AGNP, NP-C, AQH
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LEA
Other - Last Name:SHREFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 E 56TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2904
Mailing Address - Country:US
Mailing Address - Phone:563-421-0480
Mailing Address - Fax:563-421-0489
Practice Address - Street 1:1230 E RUSHOLME ST STE 207
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2400
Practice Address - Country:US
Practice Address - Phone:563-421-8980
Practice Address - Fax:563-421-8989
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH108094363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology