Provider Demographics
NPI:1497714646
Name:JIMENEZ, REBECCA S (CRNA)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:S
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1215 PLEASANT STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1418
Mailing Address - Country:US
Mailing Address - Phone:515-241-5722
Mailing Address - Fax:515-241-4403
Practice Address - Street 1:1215 PLEASANT STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1418
Practice Address - Country:US
Practice Address - Phone:515-241-5722
Practice Address - Fax:515-241-4403
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAD064621367500000X
AR123902367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0139097Medicaid
IAD064621OtherTRICARE
IA430028515OtherRAILROAD MEDICARE
IA421008717OtherJOHN DEERE
IA54421OtherBCBS
IA54421OtherBCBS