Provider Demographics
NPI:1295746329
Name:EICHMEIER, JEAN C (PA-C)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:C
Last Name:EICHMEIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5405
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:641-428-3059
Practice Address - Street 1:1010 4TH ST SW
Practice Address - Street 2:SUITE 120
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2857
Practice Address - Country:US
Practice Address - Phone:641-428-6020
Practice Address - Fax:641-428-7209
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA001073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA47307OtherWELLMARK
IAS67266Medicare UPIN
IA47307OtherWELLMARK