Provider Demographics
NPI:1578540944
Name:BOOK-DAVIN, JUDITH A (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:BOOK-DAVIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:BOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2709 W BRIGGS AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2649
Mailing Address - Country:US
Mailing Address - Phone:641-209-9944
Mailing Address - Fax:641-209-9946
Practice Address - Street 1:2709 W BRIGGS AVE
Practice Address - Street 2:STE. 1
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2649
Practice Address - Country:US
Practice Address - Phone:641-209-9944
Practice Address - Fax:641-209-9946
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA061959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0221176Medicaid
IA70948OtherBLUE CROSS BLUE SHIELD
IA0221176Medicaid
IA161848Medicare PIN