Provider Demographics
NPI:1477503621
Name:CREGER, HERMIEN (ARNP)
Entity Type:Individual
Prefix:
First Name:HERMIEN
Middle Name:
Last Name:CREGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HERMIEN
Other - Middle Name:
Other - Last Name:KOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-247-4240
Mailing Address - Fax:515-247-4239
Practice Address - Street 1:1755 59TH PL
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7737
Practice Address - Country:US
Practice Address - Phone:515-247-4240
Practice Address - Fax:515-247-4239
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104332163W00000X
IAA104332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1477503621OtherWELLMARK BCBS
IAIB1541005Medicare PIN
IAP00353603OtherRR MEDICARE
IAIB1540005Medicare PIN
IAI17644Medicare PIN
IAQ40208Medicare UPIN
IA3465955Medicaid
IA4465955Medicaid