Provider Demographics
NPI:1639459902
Name:ROMAN, JACLYN RENAE (CNM)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:RENAE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:RENAE
Other - Last Name:BEUKELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-7038
Mailing Address - Fax:319-384-8620
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-7038
Practice Address - Fax:319-384-8620
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-110110367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife