Provider Demographics
NPI:1609274760
Name:WESTFALL, JENNIFER M (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3740 UTICA RIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1657
Mailing Address - Country:US
Mailing Address - Phone:563-344-7400
Mailing Address - Fax:563-359-9395
Practice Address - Street 1:3740 UTICA RIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1657
Practice Address - Country:US
Practice Address - Phone:563-344-7400
Practice Address - Fax:563-359-9395
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012267363LF0000X
IAA132335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209012267OtherILLINOIS LICENSE
IA408010024OtherIOWA MEDICARE PTAN
IAA132335OtherIOWA STATE LICENSE
ILF400187712OtherILLINOIS MEDICARE PTAN