Provider Demographics
NPI:1922455096
Name:GUERDET, DEAN LEE
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:LEE
Last Name:GUERDET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DEAN
Other - Middle Name:
Other - Last Name:GUERDET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, PMHNP
Mailing Address - Street 1:720 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:515-576-7171
Mailing Address - Fax:515-576-7728
Practice Address - Street 1:720 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5759
Practice Address - Country:US
Practice Address - Phone:515-576-7171
Practice Address - Fax:515-576-7728
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA135196163W00000X
IAG135196363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health