Provider Demographics
NPI:1861006645
Name:HISTORIC BLUFFS FAMILY PRACTICE CLINIC., PC
Entity Type:Organization
Organization Name:HISTORIC BLUFFS FAMILY PRACTICE CLINIC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:563-213-1576
Mailing Address - Street 1:666 LORAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6233
Mailing Address - Country:US
Mailing Address - Phone:563-213-1576
Mailing Address - Fax:
Practice Address - Street 1:666 LORAS BLVD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6233
Practice Address - Country:US
Practice Address - Phone:563-213-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty