Provider Demographics
NPI:1184622425
Name:BOLHUIS, DEANNE K (ARNP)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:K
Last Name:BOLHUIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 KING DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5956
Mailing Address - Country:US
Mailing Address - Phone:319-234-5764
Mailing Address - Fax:319-234-1336
Practice Address - Street 1:432 KING DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5956
Practice Address - Country:US
Practice Address - Phone:319-234-5764
Practice Address - Fax:319-234-1336
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-078633363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0146OtherJOHN DEERE HEALTH CARE
IA417444Medicaid
IA417444Medicaid
S64628Medicare UPIN