Provider Demographics
NPI:1972867273
Name:DUSTHIMER, KATHY JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JEAN
Last Name:DUSTHIMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2347
Mailing Address - Country:US
Mailing Address - Phone:563-355-5418
Mailing Address - Fax:
Practice Address - Street 1:465 AVENUE OF THE CITIES
Practice Address - Street 2:SUITE 140
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4044
Practice Address - Country:US
Practice Address - Phone:309-755-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily