Provider Demographics
NPI:1497705594
Name:WU, JEANNETT TAN (MD)
Entity Type:Individual
Prefix:
First Name:JEANNETT
Middle Name:TAN
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-887-2900
Mailing Address - Fax:319-887-2904
Practice Address - Street 1:2769 HEARTLAND DR STE 205
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-887-2900
Practice Address - Fax:319-887-2904
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20392207R00000X
IAMD-36841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86008Medicare UPIN
274312Medicare ID - Type Unspecified