Provider Demographics
NPI:1790718302
Name:EDEKER, JENNIFER M (MSN, FNP, ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:EDEKER
Suffix:
Gender:F
Credentials:MSN, FNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1455
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1455
Mailing Address - Country:US
Mailing Address - Phone:515-471-9373
Mailing Address - Fax:
Practice Address - Street 1:160 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IA
Practice Address - Zip Code:50622
Practice Address - Country:US
Practice Address - Phone:319-984-5645
Practice Address - Fax:319-984-5364
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA104451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05190OtherWELLMARK
IA0481945Medicaid
IA0481945Medicaid
IAQ61585Medicare UPIN